Nervous System Effects of Systemic Lupus Erythematosus
AKA I spent hours suffering trying to find all this information and I want you to not have to do that!
Cerebrovascular
1. Stroke
"...studies have shown that stroke occurs more frequently in people with SLE than in the general population, with ischemic stroke developing in up to 20% of lupus patients..." link
2. Cerebral Small Vessel Disease
"CSVD is an umbrella term for a variety of conditions resulting from damage to small blood vessels in the brain. In most cases, CSVD is caused by the narrowing or obstruction of small blood vessels in the brain due to inflammation and/or a buildup of misfolded proteins called plaques. This chronic damage can starve brain cells of oxygen and cause internal bleeding, which in turn can damage other nearby brain cells." link
Diagnosed via a brain MRI to look for bleeding of the small blood vessels, damage to white matter, and small strokes - link
Occasionally is confused for Multiple Sclerosis - link
"Quantified MRI brain studies of individuals with lupus show significantly accelerated cerebral SVD, suggesting that this is the most frequently observed radiological–pathological brain abnormality in lupus...." link
CSVD is a large cause of dementia in the general population but the significance of these findings in SLE patients is unknown - link
Central Nervous System
1. Transverse Myelitis
"Transverse myelitis is a neurological condition that happens when both sides of the same section of the spinal cord become inflamed. This inflammation can damage myelin, the fatty substance that covers your nerves. Loss of myelin often leads to spinal cord scarring that blocks nerve impulses and results in physical problems." link
Symptoms can develop quickly or over the span of several weeks. Symptoms include back pain, neck pain, paresthesia, loss of bowel and/or bladder control, and heightened sensitivity to touch - link
Diagnosed via CT, MRI, or myelography - link
Differential diagnosis of comorbid Neuromyelitis Optica Spectrum Disorder - link
Transverse myelitis occurs in approximately 1% of lupus patients - link
2. Autoimmune Aseptic Meningitis
"...an inflammatory condition affecting the meninges, the protective membranes surrounding the brain and spinal cord..." - link
"Given that many individuals with lupus are immunosuppressed, a critical differential diagnosis is one of infectious meningitis caused by typical or opportunistic pathogens." - link
May cause nausea, fever, and neck stiffness among other symptoms - link
Diagnosed with a lumbar puncture and/or CT in part to rule out other causes of symptoms - link
3. Chorea
Chorea is a movement disorder causing involuntary, irregular, and unpredictable muscle movements. It affects arms, legs, and facial muscles - link
4. Parkinsonism
Causes slowed movements, tremor, and stiffness - link
Not the same as Parkinson's Disease!
A rare effect of lupus - link
Diagnosed based on brain MRI, single-photon emission computed tomography (SPECT), and response to treatment - link
5. Myoclonus
"Myoclonus is an uncontrollable muscle movement that’s sudden and brief. " link
6. Demyelinating Syndrome
"An association between lupus and MS-like brain changes have been suggested, and sometimes termed “lupoid sclerosis”" link
3.7% of patients have a demyelinating syndrome (though not all have primary SLE demyelination) - link
Demyelinating syndrome may cause vision loss, muscle weakness, muscle stiffness and spasms, loss of coordination, change in sensation, walking problems, and changes in bladder and bowel function - link
7. Lupus headache
"Headache is a highly prevalent disorder in people with SLE, but there is no convincing evidence that this incidence is higher than that seen in the general population. Thus the entity of “lupus headache” is controversial." link
One of the main characteristics of lupus headaches is that they are not remedied by pain medication. lupus headaches require treatment with steroids or immunosuppressants to resolve -- "severe, persistent headache; may be migrainous, but must be nonresponsive to narcotic analgesia" link
8. Posterior reversible encephalopathy syndrome (PRES)
"Posterior reversible encephalopathy syndrome (PRES) is a neurologic disorder in which a person presents with visual disturbance, seizure, headaches, and altered mentation" - source
"Posterior reversible encephalopathy syndrome (PRES) has been increasingly identified in patients with systemic lupus erythematosus (SLE)" - source
8. Seizures
"prevalence of explicit episodes of seizures among SLE patients, varies from 2 to 8%." - link
"SLE patients with recurrent seizures usually have abnormal findings on EEG, consistent with focal aware events, epilepsy with impaired awareness and focal to bilateral tonic-clonic epilepsy, as demonstrated by Appenzeller and colleagues who found that 9.7 % of patients with single epileptic seizure had abnormal EEG findings, compared to 100 % abnormal EEG findings, commonly on temporal lobe, in patients with recurrent seizures" - link
Peripheral Nervous System
1. Cranial Nerve Disorder
"Cranial nerve disorder refers to an impairment of one of the twelve cranial nerves that emerge from the underside of the brain, pass through openings in the skull, and lead to parts of the head, neck, and trunk. These disorders can cause pain, tingling, numbness, weakness, or paralysis of the face including the eyes." - source
"Cranial nerve involvement is also relatively uncommon and usually transient, occurring in 10% of patients with SLE." - source
2. Peripheral Neuropathy
"Peripheral neuropathy happens when the nerves that are located outside of the brain and spinal cord (peripheral nerves) are damaged. This condition often causes weakness, numbness and pain, usually in the hands and feet. It also can affect other areas and body functions including digestion and urination." - source
"Peripheral neuropathy occurs in as many as 18% of patients with SLE" - source
Ocular
1. Optic Neuritis
"The optic nerve itself can sometimes be inflamed in lupus, or it can be affected when the blood vessels supplying the nerve are themselves inflamed (that is, ischemic optic neuropathy). This can lead to a change in vision, or even vision loss." - source
"Optic neuritis is an uncommon neurologic manifestation of systemic lupus erythematosus (SLE) and can be seen in about 1% of lupus patients" - source
"Optic neuritis usually affects one eye. Symptoms might include: Pain, vision loss in one eye, visual field loss, loss of color vision, and flashing lights." - source
Autonomic Nervous System
1. Autonomic Neuropathy
"Autonomic neuropathy occurs when there is damage to the nerves that control automatic body functions. It can affect blood pressure, temperature control, digestion, bladder function and even sexual function." - source
"Autonomic nervous system dysfunction is highly prevalent in SLE patients (up to 54%)" - source
Psychiatric
1. Lupus psychosis
" Psychosis is a serious mental disorder featuring defective thought processes, frequently with delusions or hallucinations." - link
Psychosis is one of the diagnostic criteria for systemic lupus erythematosus
"Differentiation of steroid-induced psychosis from lupus-associated psychosis is particularly challenging" - link
