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Neurology (Expert Forum)
Re: cognitive dysfunction with and without lupus cerebritis
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
Re: cognitive dysfunction with and without lupus cerebritis
by CCF Neuro[P] MD RPS, Jan 01, 1995 12:00AM
Posted By CCF Neuro[P] MD, RPS on March 27, 1999 at 19:19:51:
In Reply to: cognitive dysfunction with and without lupus cerebritis posted by Janet Pedersen on March 12, 1999 at 12:49:37:
I am currently home on disability for a lupus flare. I am usually ANA negative, and the SED rate is sometimes but not always normal. I take NSAIDS and 8 mg. prednisone (current dose) along with synthroid, estrogen patch, and medicine for allergies and asthma. My question has to do with a sharp decline in my cognitive abilities over the past few months. As the flare worsened, I began having severe difficulties with short-term memory and concentration, and my speech changed. When I talk, I frequently must allow a long pause between words because I cannot "pull up" the next thing I'm going to say. I know that the content is sometimes repetitive and somewhat labile as well. I am a school psychologist, and unless or until this gets cleared up, I can't return to work. (Thinking and speaking being a prerequisite for the job!) :-) I have had a neurological consult, and he has referred me for an MRI and and EEG, and says if those are negative, he'll assume it's not the lupus and send me to a neuropsychologist to look at affective issues instead. My question is, what are the appropriate tests for CNS lupus? Does it always show up in an MRI or EEG? And if it's more subtle and requires a neuropsych exam, does that really mean it isn't the lupus? Will it likely improve? This has ramifications for my disability claim, obviously, and I need to know whether this doctor is doing enough and doing the right thing. Thanks for your help.
Dear Janet
Sorry to hear about your symptoms. In a large series reported by Johnbson and Richardson, 75% of patients with lupus have CNS involvement. Similar symptoms to what you describe were found. They may occur early and may be mild and transient, most often they develop later in the disease (likely you are one of the former). Most of the neurologic manifestations can be accounted for by widespread microinfarcts in the cerebral cortex and brainstem. Attachment of immune complexes to the endothelium is the postulated mechanism of vascular injury. In some cases, steriods tend to help symptoms resolve and in others they may precipitate other symptoms such as psychosis and muscle weakness.
It is a balancing act with steriods and lupus. Trying to balance the side effects of steriods with improvement of the disease is always difficult. There are no real good tests for CNS lupus. The MRI with added tests such as MRA to look at vessels, diffusion weighted scan to look at new infarcts help to see what has already happened. The trick is to try and prevent things. Keeping the hypertension under control if it is present, reducing the flares of the disease, etc. are important. The brain has a good response to time in healing itself. Although no one can predict how much healing will occur, some always seems to occur.
You will need to work closely with your neurologist and rheumatologist on treatment of the Lupus. It sounds like you are on the right track. I hope that things improve.
Sincerely,
CCF Neuro[P] MD
In Reply to: cognitive dysfunction with and without lupus cerebritis posted by Janet Pedersen on March 12, 1999 at 12:49:37:
I am currently home on disability for a lupus flare. I am usually ANA negative, and the SED rate is sometimes but not always normal. I take NSAIDS and 8 mg. prednisone (current dose) along with synthroid, estrogen patch, and medicine for allergies and asthma. My question has to do with a sharp decline in my cognitive abilities over the past few months. As the flare worsened, I began having severe difficulties with short-term memory and concentration, and my speech changed. When I talk, I frequently must allow a long pause between words because I cannot "pull up" the next thing I'm going to say. I know that the content is sometimes repetitive and somewhat labile as well. I am a school psychologist, and unless or until this gets cleared up, I can't return to work. (Thinking and speaking being a prerequisite for the job!) :-) I have had a neurological consult, and he has referred me for an MRI and and EEG, and says if those are negative, he'll assume it's not the lupus and send me to a neuropsychologist to look at affective issues instead. My question is, what are the appropriate tests for CNS lupus? Does it always show up in an MRI or EEG? And if it's more subtle and requires a neuropsych exam, does that really mean it isn't the lupus? Will it likely improve? This has ramifications for my disability claim, obviously, and I need to know whether this doctor is doing enough and doing the right thing. Thanks for your help.
Dear Janet
Sorry to hear about your symptoms. In a large series reported by Johnbson and Richardson, 75% of patients with lupus have CNS involvement. Similar symptoms to what you describe were found. They may occur early and may be mild and transient, most often they develop later in the disease (likely you are one of the former). Most of the neurologic manifestations can be accounted for by widespread microinfarcts in the cerebral cortex and brainstem. Attachment of immune complexes to the endothelium is the postulated mechanism of vascular injury. In some cases, steriods tend to help symptoms resolve and in others they may precipitate other symptoms such as psychosis and muscle weakness.
It is a balancing act with steriods and lupus. Trying to balance the side effects of steriods with improvement of the disease is always difficult. There are no real good tests for CNS lupus. The MRI with added tests such as MRA to look at vessels, diffusion weighted scan to look at new infarcts help to see what has already happened. The trick is to try and prevent things. Keeping the hypertension under control if it is present, reducing the flares of the disease, etc. are important. The brain has a good response to time in healing itself. Although no one can predict how much healing will occur, some always seems to occur.
You will need to work closely with your neurologist and rheumatologist on treatment of the Lupus. It sounds like you are on the right track. I hope that things improve.
Sincerely,
CCF Neuro[P] MD
