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LUPUS ERYTHROMATOSUS A TO Z
SOURCE: National Institutes of Health, U.S.Department of Health and Human Services: Link to NIH
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Central Nervous System Manifestations

Overview

Neurologic manifestations of SLE are common and vary from mild to severe. They can be difficult to diagnose and distinguish from other diseases. All portions of the nervous system may be affected, including the CNS. Definite diagnosis of CNS lupus may be difficult, as symptoms may be related to medications, other medical conditions, or individual reactions to chronic illness.

Examples of neurological manifestations include cranial or peripheral neuropathy, psychosis, coma, transverse myelitis, meningitis, cognitive impairment, mental changes, seizures, and stroke.

Cranial or peripheral neuropathy occurs in 10 to 15 percent of patients; it is probably secondary to vasculitis in small arteries supplying nerves. Cerebrovascular accidents (strokes) are reported in approximately 15 percent of patients. Between 10 and 20 percent of patients experience seizures. Although cognitive impairment is believed to be very common, formal cognitive function testing may be required in order to document it.

Serious CNS involvement ranks behind only kidney disease and infection as a leading cause of death in lupus. However, the majority of SLE patients with CNS complications do not develop a life-threatening disease.


Potential CNS Manifestations

General CNS lupus
  • headaches1
  • confusion
  • seizures
  • psychosis
  • numbness
  • paralysis
  • coma
  • aphasia
Cranial neuropathies
  • visual defects
  • blindness
  • nystagmus (involuntary movement of the eyeball)
  • ptosis (paralytic drooping of the eyelid)
  • papilledema (edema in the optic disk)
  • tinnitus
  • vertigo
  • facial palsy
Cognitive impairment
  • Confusion
  • Impaired long- and short-term memory
  • Difficulty in conceptualizing, abstracting, generalizing, organizing, and planning information for problem solving
  • Difficulties in personal and extrapersonal orientation
  • Altered visual-spatial abilities
  • Selective attention
  • Difficulties in pattern recognition, sound discrimination and analysis, and visualmotor integration
Mental changes
  • Depression
  • Anxiety
  • Affective disorder
  • Mood swings
  • Hypomania or mania (especially with corticosteroid use)
Rare CNS manifestations
  • Movement disorder
  • Aphasia
  • Coma


Potential Problems

1. alteration in mental status, cognition, and perception

2. altered ability to perform activities of daily living and meet family responsibilities

3. potential for injury

Nursing Interventions

Objective: Develop a plan for the patient to perform activities of daily living appropriately and independently.

1. Assess and document the patientís mental status to determine her or his capabilities:

  • general appearance
  • unusual body movements
  • speech patterns and word use
  • alertness and orientation to time, place, and person
  • memory of remote and recent past
  • perception of self and environment
  • affect and emotional stability
  • ability to solve problems
  • presence of depression.
2. Support the patientís need to maintain some control over daily activities and decisions:
  • Encourage the patient to plan and participate in daily routines.
  • Set aside time to develop trust and rapport with the patient, and be consistently truthful (patients are keenly aware of inconsistencies in information provided).
3. Encourage the patient to discuss the effects of SLE on her or his personal life and coping methods. Allow expressions of fear and anger.

Objective: Assist the patient in identifying family and community support services.

1. Assess the patientís support network. Discuss alternatives for strengthening supports.

2. Anticipate family concerns. Seek out family members to answer their questions and to provide support. Include significant others in patient care as appropriate.

3. Help the family identify potential coping skills, environmental supports, and community services for dealing with chronically ill people.

4. Encourage patient and family members to consider professional counseling.

Objective: Minimize potential for injury.

1. Assist the patient and family in identifying and removing potentially dangerous items in the environment.

2. Involve family members in planning the patientís care and safety measures.

3. Assess the patientís ability to safely administer her or his own medications.

Note: For additional information, see the Patient Information Sheet on Living With Lupus and Serious Conditions Associated With Lupus.



Source: National Institutes of Health, U.S.Dept of Health and Human Services


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