Neuropsychiatric features of SLE

Headache and migraine are the most common neurological symptoms of SLE, though they are not specific to itShaban, 2019.

Cerebral vasculopathy is a common feature of neurological disease in SLEShaban, 2019. Cerebral arterial or venous thrombosis may be associated with accelerated atherosclerotic small- or large-vessel vasculopathies and cause symptoms and signs of stroke. It may also be associated with antiphospholipid syndrome in SLE.

Note: Any suspicion of serious neuropsychiatric features of SLE should prompt urgent specialist referral.

Neuropsychiatric features of SLE are rare. Any suspicion of serious neuropsychiatric features of SLE, that could indicate cerebral involvement, should prompt urgent specialist referral (eg rheumatologist, neurologist, psychiatrist). Serious neuropsychiatric features of SLE includeSchwartz, 2019:

  • delirium—acute change in consciousness, level of arousal, cognition or behaviour
  • psychosis in the absence of delirium
  • seizures—primary generalised or focal (partial)
  • immune complex–mediated cerebral vasculitis—rare but carries a grave prognosis, even with aggressive treatment; usually associated with other systemic inflammatory features
  • cranial neuropathy (eg optic neuropathy), peripheral neuropathy, mononeuritis multiplex—usually associated with vasculitisShaban, 2019
  • transverse myelitis—usually associated with a demyelinating or vasculitic inflammatory lesion of the spinal cordShaban, 2019.

Neuropsychiatric SLE is difficult to distinguish as many of the features could be primary disease in themselves, or associated with adverse effects of drugs (eg systemic corticosteroids). Comorbid psychiatric disorders (eg depression, thought disorder, psychosis) can occur with SLE and specific psychiatric management is indicated, in addition to treatment for SLE.