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In regard to therapy, it is first important to realize that neurologic involvement in lupus is

common [62]. Second, in the vast majority of patients there is complete resolution of
neurologic problems over time, provided they are addressed properly. If the neurologic
symptoms present dramatically, ie, with fits or severe neuropsychiatric disease, the treatment
(as with most active forms of lupus) should be with steroids and immunosuppressive drugs.
The doses of steroids used are less than previously utilized (for example, 60mg daily in the
majority of the worst cases); rarely is a higher dose required. An alternative way of giving
steroids is by pulse injections on an intermittent basis [59-61]. The puse method is
becoming more popular, as it is a simple and more rapidly effective way of administrating
steroids, especially in emergencies. As previously noted, a distinct form of brain involvement
in lupus is associated with the antiphospholipid or Hughes syndrome [62]. In this
complication, the neurologic etiopathogenesis is secondary to microthrombi in neural blood
vessels. In patients where the antiphospholipid syndrome is suspected, brain scans are usually
performed. The brain scans may show localized areas where blood supply has been
inadequate. The treatment in these patients requires thinning of the blood, either with aspirin
or, in more severe cases with anticoagulants such as warfarin (Coumadin) [62]. For less
dramatic brain involvement, the decision to treat is more problematic. Many patients are not
treated, who should be treated. In some patients, depression is a major problem and requires
conventional anti-depressive treatment. The more modern medications for depression are
superior to older medications, causing far less side effects. The opinion of a psychiatrist may
be sought to address whether medical psychiatric treatment is appropriate, especially given
the dangers of drug interactions. In summary, the vast majority of patients who experience
lupus brain involvement may be treated successfully and return to normal daily activities [59-
61]. Anxiety and depression are common symptoms felt by lupus patients.
Finally, other neurologic sequelae may present in lupus patients. Central nervous system
vasculitis represents inflammation of the blood vessels of the brain. It is characterized by high
fevers, psychosis, seizures, and meningitis-like neck stiffness, leading to stupor and coma if
not quickly and aggressively treated [63,64]. Cognitive dysfunction may occur in lupus, and
may include memory loss, loss of concentration, confusion and difficulty expressing
thoughts. Cognitive dysfunction may present as an intermittent or constant clinical problem; it
is sometimes referred to as "lupus brain fog". Also, up to 30% of people with lupus have a
simultaneous fibromyalgia, evidenced by tender points and increased pain in the soft tissues.
Patients with a fibromyalgia may also experience cognitive dysfunction, difficulty sleeping,
and lack of stamina. As previously noted, lupus headaches may present with a migraine
character [59-61]; these headaches are more common in lupus patients with antiphospholipid
syndrome or Raynaud's phenomenon. These severe headaches are often treated similar to
other migraines; although corticosteroids are also usually helpful, distinguishing it from other
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types of migraines. Intracranial hypertension (pseudotumor cerebri) is a rare complication of

lupus and can also be caused by the medications used to treat lupus. The most common
symptoms are severe non-specific headaches, transient altered vision, and tinnitus [59-61].
Other symptoms may include a stiff neck, back pain, double vision, pain behind the eyes, and
exercise intolerance. Diagnosis is achieved via 1) a complete eye examination, 2) tests to rule
out other causes of increased intercranial pressure and 3) a high opening pressure on lumbar
puncture (spinal tap). Peripheral neuropathy is a symptom most commonly associated with
diabetes; however, peripheral neuropathy may also be encountered in lupus. Peripheral
nerves, in contradistinction to cranial nerves, represent nerves located in the arms, legs and

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