Clinical and radiological features of neuropsychiatric systemic lupus erythematosus: Case series from East Africa

Abstract

Neurological and psychiatric manifestations of Systemic Lupus Erythematosus (NPSLE) are clinically diverse, may occur early in the disease, and can be the first manifesting symptom. A high index of suspicion is thus required in such cases to allow timely diagnosis and appropriate treatment in order to avoid irreversible damage of the brain. Magnetic Resonance Imaging (MRI) may offer a diagnostic clue, and several patterns have been described in the literature. We present here a series of cases of NPSLE with index neurological symptoms and uncommon MRI brain findings: diffuse white matter changes, optic tract signal change, slow dural venous sinus flow, and large non-dominant hemisphere stroke. The diagnosis of NPSLE was missed in the initial presentations, but was only made when the clinical picture, these MRI features and laboratory findings were put together for each case. Our case series highlight the broad spectrum of neurological manifestations and MRI brain scan findings in NPSLE.