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. May not be reproduced in any form without permission from the publisher, except fair uses permitted under 22 Ana Maria Abreu Velez and Michael S. Howard

rapid heartbeat. Chronic pancreatitis may cause anemia, an inability to digest food, diabetes
and jaundice [55-58].

Lupus and the Central Nervous System

Physicians are now recognizing the importance of subtle forms of brain involvement in
lupus, as well as more clinically evident problems [59-61]. Brain disease in lupus may present
with mild depression, memory loss, or more severe problems such as seizures. In general,
there are two primary causes of brain disease in lupus. The first is the disease itself, which
may cause alterations in the brain activity. The second is a clotting disorder presenting in
some lupus patients, specifically the antiphospholipid or Hughes syndrome [62]. It is
important for the physician to distinguish between these two major causes, as their respective
treatments are distinctly different. Depression is an integral symptom of lupus in some
patients; indeed, therapy of lupus itself often relieves the depression [59-61]. In more severe
cases, management of depression in lupus may depend on treating the lupus itself combined
with additional antidepressant therapy. One of the significant psychiatric advances of the last
decade has been the introduction of milder antidepressants, with less severe side effects as
those encountered with many earlier medications. Headaches are common in lupus. In some
patients a history of headache going back to their early teens is feature of the disease [59-61].
The headaches may be a part of the lupus itself, or may be associated with antiphospholipid
syndrome. The headaches may present with a migraine character, including visual
disturbances and severe pain. In any lupus patient with headaches, a systematic workup
should be performed including examination of blood pressure, sinuses, blood and if indicated,
a brain scan (either MRI or CT) [59-61]. Sometimes, lupus may initially present in a dramatic
way, with a seizure or a series of epileptic fits. Such a presentation may also represent an
important feature of the antiphospholipid syndrome [62]. Fits or seizures are one of the non-
specific ways the brain reacts to severe illness. Once the lupus is treated, further fits are the
exception rather than the rule. Other movement disorders may also be encountered in lupus.
Occasionally, patients develop chorea (Saint Vitus dance) with jerky hand or head
movements. The chorea is simply a manifestation of abnormal brain function and once again,
is often associated with Hughes syndrome [62]. Spinal cord complications are a rare, acute
and dangerous complication of lupus, which may lead to permanent paralysis. It is now
recognized that immediate treatment with both steroids and anticoagulants may prevent any
potential spinal cord injury. A variety of psychiatric and behavioral disorders have been
described in SLE, ranging from mild personality disorders to severe psychotic behavior [59-
62]. Some lupus patients are incorrectly diagnosed with schizophrenia at the initial
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presentation of their illness. Interestingly, treatment of the lupus in these patients results in
total improvement in the psychiatric features. The rapid resolution is one of the most
important observations gleaned from recent lupus research, as it provides possible insights
into other mental diseases. Patients with the antiphospholipid syndrome may suffer memory
impairment, from subtle to severe memory loss [62]. Physicians treating lupus patients are
now confirming this important aspect of the disease. Clearly, any patient who presents with
this feature of the disease requires a full neurologic examination, possibly including a MRI
scan, as well as testing for the antiphospholipid syndrome.

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