Cerebral lupus: Report of a Meeting of Physicians, United Medical and Dental Schools of Guy's and St Thomas' Hospitals and Guy's Hospital, London

Nervous system involvement has been recorded in 10 to 75% of different series of patients with systemic lupus erythematosus (SLE) and it is especially common in the terminal, uncontrolled stages of the disease.’ De novo presentation with neurological symptoms, however, is rare2 and difficult to diagnose. The commonest features are psychotic and depressive illnesses, confusional states, cognitive impairment, epilepsy, and stroke-like illnesses. Other signs include cranial nerve palsies, multiple mononeuropathies, and chorea. Since many patients with central nervous system (CNS) involvement also have severe hypertension that is often very difficult to control, it may be hard to distinguish encephalopathy related to uncontrolled blood pressure from cerebral involvement due to true cerebral lupus. Moreover, since treatment of the vasculitis often requires profound immunosuppression, supervening infection of the CNS must always be considered as a part of the differential diagnosis of a new neurological illness in a
patient undergoing such treatment. It is against this background that advances in imaging and serology have contributed to an earlier and more specific diagnosis of cerebral lupus, thus providing a greater understanding of its natural history.