Neuropsychiatric manifestations in systemic lupus erythematosus

Neuropsychiatric systemic lupus erythematosus (NPSLE) has become a popular term designing all neurological and psychiatric complications in patients with systemic lupus erythematosus (SLE). It occurs in up to two thirds of all SLE patients and it covers a vast array of disorders ranging from peripheral neuropathy to stroke, psychosis, and dementia. Mechanisms associated with the pathogenesis of NPSLE include anti-neuronal antibodies, antiphospholipid antibody associated thrombosis, emboli from cardiac source and, rarely, vasculitis by immune complex depositions. Although the most common manifestations is cognitive dysfunction (50%), NPSLE may also present itself as peripheral neuropathy (15%), psychosis (10%), or other central nervous system abnormalities (stroke, organic brain syndrome, seizures). In lupus patients, one should always look for secondary causes of the neuropsychiatric manifestation, including infection, toxic metabolic abnormalities, and hypertension. We present two cases of SLE, which developed neuropsychiatric manifestations.