scholarly journals Pearls & Oy-sters: An unusual neuropsychiatric manifestation of systemic lupus erythematosus

Neurology ◽  
2018 ◽  
Vol 90 (21) ◽  
pp. e1929-e1932
Author(s):  
David Dongkyung Kim ◽  
Charles Ho ◽  
Rebecca King ◽  
Sarah A. Morrow
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Neuropsychiatric Manifestation

Rapid-Onset Weakness and Numbness in a Patient With Systemic Lupus Erythematosus

2021 ◽  
pp. 120-121
Author(s):  
Floranne C. Ernste
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cerebrospinal Fluid ◽  
Lupus Erythematosus ◽  
White Blood Cells ◽  
Cauda Equina ◽  
Transverse Myelitis ◽  
Lower Extremities ◽  
Systemic Lupus ◽  
Neuropsychiatric Manifestation ◽  
Fluid Analysis

A 33-year-old woman with systemic lupus erythematosus, diagnosed 2 years prior and treated with hydroxychloroquine, sought care for a 4-week history of pain and paresthesias in her low back and lower extremities. She described a bandlike sensation of numbness starting in her midback which descended to both legs. Her symptoms progressed to constipation and inability to urinate adequately. She reported difficulty with ambulation. Over the course of 1 week of hospitalization, urinary and fecal incontinence developed. On examination, she was alert and appropriately oriented. She had a malar rash and swelling of the metacarpophalangeal joints consistent with bilateral hand synovitis. Neurologic examination indicated hyperreflexia with brisk patellar and Achilles tendon reflexes bilaterally. She had trace motor weakness of the hip flexors, quadriceps, and hamstrings. She had loss of pinprick and temperature sensation in the lower extremities, extending beyond the saddle area to the T12 dermatome. Vibration perception and proprioception were preserved. She had a positive Babinski sign in the left foot. Her cerebellar examination showed slowing of rapid alternating movements in the left hand. Magnetic resonance imaging of the lumbosacral spine indicated subtle T2 signal change of the intramedullary conus and enhancement of the cauda equina nerve roots. Cerebrospinal fluid analysis showed an increased protein concentration. Two white blood cells/µL were found in the cerebrospinal fluid. The serum antinuclear antibody was strongly positive, and the anti–double-stranded DNA antibody level was greater than 1,000 IU/mL. The serum complement levels were low. Lupus anticoagulant, beta-2 glycoprotein antibodies, and antiphospholipid antibodies were increased, at greater than twice the upper limits of normal. Electromyography indicated multiple sacral radiculopathies. The patient was diagnosed with autoimmune myeloradiculitis as a neuropsychiatric manifestation of systemic lupus erythematosus (neuropsychiatric systemic lupus erythematosus). The patient received methylprednisolone followed by prednisone, with a gradual taper. Her hospital course was complicated by the development of deep venous thromboses in the bilateral lower extremities. She was started on heparin and transitioned to warfarin therapy. She started mycophenolate mofetil. Hydroxychloroquine was continued. At a 24-month follow-up visit, the patient remained in neurologic remission. Neuropsychiatric systemic lupus erythematosus events consist of a heterogeneous array of neurologic and psychiatric disorders including intractable headaches, cognitive dysfunction, psychosis, seizure disorders, transverse myelitis, aseptic meningitis, cranial neuropathies, and acute inflammatory demyelinating polyneuropathy.

scholarly journals Fulminant Guillain-Barré syndrome in a patient with systemic lupus erythematosus

2019 ◽  
Vol 12 (1) ◽  
pp. bcr-2018-226634 ◽  
Author(s):  
Eric Anthony Coomes ◽  
Hourmazd Haghbayan ◽  
Jenna Spring ◽  
Sangeeta Mehta
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Axonal Neuropathy ◽  
Guillain Barre Syndrome ◽  
Systemic Lupus ◽  
Outward Appearance ◽  
Intravenous Immunoglobulin Therapy ◽  
Neuropsychiatric Manifestation ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

A 45-year-old man with a history of systemic lupus erythematosus presented with progressive weakness and areflexia. Electromyogram revealed reduced motor and sensory amplitudes without demyelinating features. He was clinically diagnosed with the acute motor and sensory axonal neuropathy variant of Guillain-Barré syndrome. Despite intravenous immunoglobulin therapy, he deteriorated with loss of all voluntary motor function and cranial nerve reflexes. Concomitant investigations revealed class V lupus nephritis. Therapy was initiated with plasma exchange, glucocorticoids and further immunosuppression, with gradual neurological recovery. We present the first documented case of fulminant Guillain-Barré syndrome as a neuropsychiatric manifestation of systemic lupus erythematosus, highlighting how immune-mediated polyneuropathy via diffuse deafferentation may mimic the outward appearance of brain death. While glucocorticoids are not indicated in idiopathic Guillain-Barré, when this neurological disorder is a consequence of systemic lupus erythematosus, immunomodulatory treatment should be initiated to prevent neurological deterioration.

Posterior reversible encephalopathy syndrome: A neuropsychiatric manifestation of systemic lupus erythematosus

2020 ◽  
pp. 102739
Author(s):  
Martín Valdez-López ◽  
Eduardo Aguirre-Aguilar ◽  
Sergio Iván Valdés-Ferrer ◽  
Francisco M. Martínez-Carrillo ◽  
Antonio Arauz ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Posterior Reversible Encephalopathy ◽  
Neuropsychiatric Manifestation ◽  
Reversible Encephalopathy

scholarly journals Idiopathic intracranial hypertension as a cause of severe intractable headache in a patient with Systemic Lupus Erythematosus: A case report from Eastern Nepal

2018 ◽  
Vol 7 (2) ◽  
pp. 40-42
Author(s):  
Bhupendra Shah ◽  
Mathew Ibrahim Amprayil ◽  
Rahul Taparia ◽  
Shailesh Mani Pokhrel
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Intracranial Hypertension ◽  
Lupus Erythematosus ◽  
Idiopathic Intracranial Hypertension ◽  
Female Gender ◽  
Systemic Lupus ◽  
Hypervitaminosis A ◽  
Neuropsychiatric Manifestation ◽  
History Of

Correction: Unfortunately, several authors on this paper were omitted. Therefore, on 15th April 2019 the following authors were added to the paper: Mathew Ibrahim Amprayil, Rahul Taparia and Shailesh Mani Pokhrel. The editorial board apologises for this error. The common risk factors for Idiopathic intracranial hypertension are obesity, female gender, hypervitaminosis A, and steroid withdrawal. Even though Idiopathic intracranial hypertension is considered as a neuropsychiatric manifestation of Systemic lupus erythematosus, it is often missed by the physician as a cause of a headache in a patient with Systemic lupus erythematosus. We report a case of 21-year-old female who presented in our outpatient department with a history of a severe intractable progressive headache for a duration of four weeks and blurring of vision for five days who was later diagnosed as a case of idiopathic intracranial hypertension with Systemic lupus erythematosus. She recovered dramatically with the institution of steroid and acetazolamide therapy.

scholarly journals MANIFESTASI NEUROPSIKIATRIK PADA LUPUS ERITEMATOSUS SISTEMIK DI RSUD DR. SOETOMO SURABAYA

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Nadya Rinda Eka Rana ◽  
Awalia Awaliah ◽  
Yetti Hernaningsih ◽  
Hanik Badriyah Hidayati
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cerebrovascular Disease ◽  
General Hospital ◽  
Lupus Erythematosus ◽  
Clinical Manifestations ◽  
Systemic Lupus ◽  
Neuropsychiatric Manifestation ◽  
American College Of Rheumatology ◽  
Common Diagnosis ◽  
Neuropsychiatric Manifestations

    NEUROPSYCHIATRIC MANIFESTATION AMONG SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS IN GENERAL HOSPITAL SURABAYAABSTRACTIntroduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with unknown causes and extensive clinical manifestations and diverse disease pathways. The clinical manifestations of SLE are very diverse, including the involvement of the nervous system and psychiatric syndrome (neuropsychiatric).Aims: To describe clinical neuropsychiatric manifestations of   patients with SLE in Soetomo General Hospital Surabaya.Methods: This was a cross-sectional study based on medical record data on all SLE patients treated at Dr. Soetomo Hospital Surabaya, from January-December 2017. Neuropsychiatric manifestations assessment were based on the nomenclature of the American College of Rheumatology (ACR) in 1999.Results: There were 49 patients, mostly women (98%) with mean age 30,8±10,2 years old. Neurological manifestation was the 3rd  most common diagnosis (43%) after hematologic disorder (73.5%) arthritis (53.1%). The manifestations of neuropsychiatric manifestation were mainly seizures (40.8%), headache (34.7%), cerebrovascular disease (26.5%), acute confusional state (20.4%), cognitive dysfunction (6.1%), and polyneuropathy (8.2%).Discussion: The most common neuropsychiatric clinical features in SLE patients are seizures, headache, cerebrovascular disease, and acute confusional state.Keywords: Lupus neuropsychiatry, prevalence, systemic lupus erythematosusABSTRAKPendahuluan: Lupus eritematosus sistemik (LES) merupakan penyakit inflamasi autoimun kronik yang belum diketahui penyebabnya dengan perjalanan penyakit yang luas. Manifestasi klinis LES sangat beragam, antara lain keterlibatan sistem saraf dan sindrom psikiatri (neuropsikiatri).Tujuan: Untuk mengetahui manifestasi neuropsikiatrik pasien dengan LES di RSUD Dr. Soetomo, Surabaya.Metodologi: Penelitian potong lintang berdasarkan data rekam medik terhadap semua pasien LES yang dirawat di RSUD Dr. Soetomo, Surabaya, pada bulan Januari hingga Desember 2017. Manifestasi neuropsikiatrik dinilain berdasarkan nomenklatur American College of Rheumatology (ACR) tahun 1999.Hasil: Didapatkan 49 subjek yang hampir semuanya (98%) adalah perempuan dengan rerata usia 30,8±10,2 tahun. Gangguan neurologis merupakan ketiga tersering (43%) setelah gangguan hematologi (73,5%) dan artritis (53,1%). Manifestasi neuropsikiatri terutama kejang (40,8%), nyeri kepala (34,7%), penyakit serebrovaskular (26,5%), keadaan konfusi akut (20,4%), dan polineuropati (8,2%).Diskusi: Manifestasi klinis neuropsikiatri yang paling banyak dialami oleh pasien LES adalah kejang, nyeri kepala, penyakit serebrovaskular, dan keadaan konfusi akut.Kata kunci: Lupus eritematosus sistemik, manifestasi klinis, neuropsikiatri  

scholarly journals INTERNUCLEAR OPHTHALMOPLEGIA AS A NEUROPSYCHIATRIC MANIFESTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS.

2019 ◽  
Author(s):  
VANI ABREU SOUZA FILHO ◽  
ALOMA GUINAMI SCABORA ◽  
CAMILLE CONSTANZO CODOGNO POSTIGO CASTRO ◽  
MARÍLIA BULHÕES CALHEIROS ◽  
YVES GLAUBER SILVA SANTOS ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Internuclear Ophthalmoplegia ◽  
Systemic Lupus ◽  
Neuropsychiatric Manifestation

scholarly journals Neuropsychiatric Manifestation Screening among Systemic Lupus Erythematosus Patients in Hasan Sadikin General Hospital Bandung

2018 ◽  
Vol 9 (2) ◽  
Author(s):  
Septian Dwi Putra ◽  
Mulya Nurmansyah Ardisasmita ◽  
Laniyati Hamijoyo
Keyword(s):  
Systemic Lupus Erythematosus ◽  
General Hospital ◽  
Sex Education ◽  
Lupus Erythematosus ◽  
Screening Method ◽  
Systemic Lupus ◽  
Neuropsychiatric Manifestation ◽  
Common Diagnosis ◽  
Neuropsychiatric Manifestations ◽  
Diagnosis Criteria

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune diseases caused by deposition of immune complex with the involvement of various organ system and certain autoantibodies production. One of the most significant manifestation is neuropsychiatricsymptoms, known as NPSLE (Neuropsychiatric Systemic Lupus Erythematosus). This study aims to portray the distribution of neuropsychiatric manifestation of SLE patients using a screening method in Hasan Sadikin General Hospital.Method: An observative, descriptive categoric study, with consecutive sampling were done. Data were collected by spreading the questionnaire to subjects diagnosed as SLE who visiting Hasan Sadikin General Hospital during August-October 2016 and by tracingtheir medical records. Data analyzed included age, sex, education background, duration of lupus, diagnosis criteria, ongoing therapy, and neuropsychiatric manifestation.Result: Samples volunteered in this study were 97 patients. Of them 94 patients (96.9%) were women and 47 patients (48.5%) were senior high school graduated. Most common diagnosis criteria found was positive ANA test (91.8%). Most necessary ongoing therapygiven was methylprednisolone (96.9%). Common neuropsychiatric manifestations were mood disorders (73,2%), headache (57,7%), and mononeuropathy (51,5%).Conclusion: The common psychiatric, central nervous, and peripheral nervous manifestations were mood disorder, headache, and mononeuropathy, respectively.Keywords: Neuropsychiatry, NPSLE Screening,Systhemic Lupus Erythematosus

scholarly journals Concomitant Guillain Barre Syndrome and Transverse Myelitis as Initial Neuropsychiatric Manifestation in a Case of Lupus: A Diagnostic Quandary

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Anshuman Srivastava ◽  
Bijit Kumar Kundu ◽  
Diwakar Kumar Singh
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Nervous System ◽  
Lupus Erythematosus ◽  
Transverse Myelitis ◽  
Guillain Barre Syndrome ◽  
Systemic Lupus ◽  
Neurologic Manifestation ◽  
Neuropsychiatric Manifestation ◽  
Neuropsychiatric Manifestations ◽  
Guillain Barré

Neuropsychiatric manifestations of systemic lupus erythematosus are varied. Presently nineteen in number, they are classified as whether affecting the central or the peripheral compartments of the nervous system. Its diagnosis however remains difficult, more so when two or more of the syndromes are found concomitantly in the same patient and when they occur in absence of the more classical rash, serositis, and haematological manifestations. We present a case of lupus where myelopathy as well as demyelination existed simultaneously as the initial neurologic manifestation.

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