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 patient's 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.

• 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).