"CT: small vessel disease is characterised by diffuse symmetrical hypodensities 11-14"
"MRI: small vessel disease is characterised by subcortical and periventricular white matter lesions on T2-weighted sequences 11-14"
"CT: hypodense lesion 11-14,22"
"MRI: varying intensity (see ischaemic stroke) 11-14"
"CT: acutely hyperdense with hypodense perihaematomal oedema 11,13,22"
"CT: hyperdense sinus reflective of thrombosis 11"
"MRI: variable appearance (see dural venous sinus thrombosis) 11"
"angiography: filling defect in affected venous sinus 11"
"CT: multiple scattered hypodensities 16"
"MRI: non-specific white matter hyperintensities on T2-weighted sequences 16,22, there may or may not be gadolinium-enhancing lesions on T1-weighted sequences 22"
"angiography: focal segmental vascular narrowing and beading may be seen 12,16"
"CT: most commonly hypodensity in the occipital and parietal regions 11"
"MRI: affected regions are hypointense on T1-weighted sequences, hyperintense on T2-weighted sequences, and may have variable enhancement and haemorrhage 11,22"
"CT: variable enlargement of the cord and variable enhancement 11,17"
"MRI: cord lesions that are hyperintense on T2-weighted sequences with variable enhancement 11,17, longitudinally extensive lesions are more likely to be associated with NMOSD 25"
"CT: often unremarkable 17"
"MRI: optic nerve lesion that is hyperintense on T2-weighted sequences and enhancing post-gadolinium administration 17,22"
"CT: may be normal 18"
"MRI: leptomeningeal enhancement that may be either focal or diffuse 18"
"MRI: see anti-NMDAR encephalitis"
"MRI: see idiopathic intracranial hypertension (IIH)"
"MRI: optic nerve lesion that is hyperintense on T2-weighted sequences and enhancing post-gadolinium administration 17,22"
"drug–induced toxic leukoencephalopathy (e.g. methotrexate-related leukoencephalopathy)"
"It is unclear how common neuropsychiatric manifestations occur in patients with SLE, due to the heterogeneity of its definition within the literature 26. As such, estimates range from 12-95% 1,26."
"regardless, up to 40% of patients with SLE experience at least one severe headache per year, which may or may not have other migrainous features or features of idiopathic intracranial hypertension, as per non-SLE patients with migraine 3,4"
"the aetiology remains uncertain, however patients are more likely to be positive for anti-ribosomal P antibodies and anti-NMDAR antibodies; vasculitis can also present with psychosis 5,9"
"although generally thought to be non-melancholic in nature, brought on by the patient’s reaction to managing their chronic illness, there may be other factors involved such as positive anti-ribosomal P antibodies or anti-NMDAR antibodies 4,5"
"similar to mood disorders in SLE, anxiety is generally thought to be brought on by the patient’s reaction to managing their chronic illness, but there may be other factors involved such as positive anti-ribosomal P antibodies or anti-NMDAR antibodies 3-5"
"The anti-ribosomal P (anti-Rib-P) antibody, which is highly specific for SLE, may be particularly associated with CNS lupus 22,24. Of relevance to the CNS, patients with SLE may also be positive with antiphospholipid antibodies (10-44%), anti-NMDAR (30-40%), and anti-AQP4 (2-3%, but 27% in CNS lupus) 22."
"although not described in the ACR criteria, PRES may develop secondary due to hypertension (e.g. lupus nephritis, corticosteroid use) and other complications of SLE (e.g. TTP) 11,19,22"
"anti-NMDAR encephalitis"
"although not described in the ACR criteria, anti-NMDA receptor antibodies have been associated with psychiatric symptoms of CNS lupus, and resultant anti-NMDAR encephalitis has also been rarely described 20,22"
"although not described in the ACR criteria, anti-NMDA receptor antibodies have been associated with psychiatric symptoms of CNS lupus, and resultant anti-NMDAR encephalitis has also been rarely described 20,22"
"MRI: see anti-NMDAR encephalitis"
"CT: acutely hyperdense with hypodense perihaematomal oedema 11,13,22"
"CT: hyperdense sinus reflective of thrombosis 11"
"CT: may be normal 18"
Expected headings
"Neurological"
"Psychiatric"
"Cerebrovascular manifestations"
"Neuroinflammatory manifestations"
"Other manifestations"
"Complications"
"Central nervous system manifestations of systemic lupus erythematosus (CNS lupus), also known as neuropsychiatric systemic lupus erythematosus (NPSLE), describe a very diverse and heterogeneous range of neuropsychiatric manifestations that are thought to be secondary to systemic lupus erythematosus (SLE) in the central nervous system (CNS)."
"CNS lupus can be a controversial and vague entity. Although the American College of Rheumatology (ACR), in 1999, defined 19 distinct central and peripheral neuropsychiatric syndromes that can occur in SLE, twelve of which are due to CNS involvement, these syndromes were defined prior to the characterisation of many novel autoimmune conditions that better explain the aetiopathogenesis of these syndromes 2-7,22,26. These conditions, such as neuromyelitis optica spectrum disorder (NMOSD), may occur concurrently with SLE 23,26. This makes the diagnosis of 'true' CNS lupus challenging 26."
"it can manifest as both vaso-occlusive disease, such as ischaemic stroke, transient ischaemic attack (TIA), and dural venous sinus thrombosis, along with intracerebral haemorrhage 3,4,8,22"
"risk factors for stroke due to SLE include antiphospholipid antibodies (present in 10-44% of patients), cerebral vasculitis (lupus angiitis), hypertension, accelerated atherosclerosis (e.g. due to prolonged corticosteroid use), cardiac valvular disease (e.g. Libman-Sacks endocarditis), thrombocytopenia, and age 3-5,8,22"
"may be due to small vessel disease, vasculitis or demyelination 3-5,22"
"the aetiology remains uncertain, however patients are more likely to be positive for anti-ribosomal P antibodies and anti-NMDAR antibodies; vasculitis can also present with psychosis 5,9"
"the aetiology again is uncertain and thought to be multifactorial, with small vessel dementia being a significant contributor; vasculitis can also present with delirium 3-5"
"drug–induced toxic leukoencephalopathy (e.g. methotrexate-related leukoencephalopathy)"