Cognitive dysfunction: Lupus patients frequently complain of confusion, profound fatigue, difficulty in articulating thoughts, and memory impairment. While blood testing confirms the presence of Lupus, other laboratory tests are usually normal. Conventional imaging and CSF examination are usually normal. A superficial mental state exam performed in a physicians office usually does not reveal any abnormalities, but more detailed neuropsychiatric testing usually reveals abnormalities in focusing, attention span, task completion, memory and decreased problem solving capabilities. A SPECT scan (a radionuclear brain scan) usually shows some abnormalities. Currently, cognitive dysfunction is thought to be caused by circulating chemicals called cytokines, and blood flow abnormalities to different parts of the brain. Cognitive dysfunction must be differentiated from depression, fibromyalgia, and behavioral alterations due to medication, infections, strokes, sleep disorders and other brain abnormalities. Usually, the symptoms of cognitive dysfunction are intermittent. Corticosteroids are have not been shown to be effective, but anti-malarials such as plaquanil and quinacrine could be helpful. Tricyclic antidepressants, or selective serotonin uptake inhibitors (prozac, zoloft, lexapro, effexor, cymbalta etc.) may be helpful, and cognitive behavioral therapy, and EEG or regular biofeedback may be very useful. Lastly, DHEA, St. John’s Wort and gingko biloba are complementary medicine alternatives.
Organic Brain syndrome: When lupus patients have a stroke or lupus vasculitis insult, these lesions may heal with scarring, which results in a permanent motor, sensory or mental deficit or even seizures. This condition resulting from a permanent damage to the CNS is known as organic brain syndrome. Its importance lays in its recognition, since there is no need to treat these lesions with immunosuppressive medicines, but they are treated symptomatically or with anti-seizure medications.
Other manifestations of CNS lupus: Abnormalities of the peripheral nerves are seen with frequency in lupus patients. This leads to painful neuropathy with tingling and numbness of the extremities. Pharmaceutical agents used to treat lupus may affect the CNS. For example, the non-steroidal anti-inflammatory drugs such as indomethacin, tolmectin, sulindac and ibuprofen have been associated with headaches. Very high doses of anti-malarials have been associated with manic behavior and psychosis as have corticosteroids. Infections of the CNS can mimic CNS lupus. Infections such as TB, meningococcus, staphylococcus, and streptococcus are common in SLE. Lastly, opportunistic infections (they occur in patients being treated with high doses of steroids or immunosuppressive medications, by pathogens that are not normally harmful), can mimic lupus and need to be excluded when considering a diagnosis of CNS lupus.
Please let me know if the above information was helpful or if you need anything further. I wish you the very best.
Peace and Blessings
Look For The Good and Praise It!