DIFFERENT CLINICAL MANIFESTATION OF CEREBRAL LUPUS DUE TO DIFFERENT BRAIN INVOLVEMENT. A REPORT OF TWO CASES
ABSTRACT: Involvement of the
nervous system in systemic lupus
erythematosus (SLE) is frequent. The most often clinical manifestations include
psychosis, mood disorders, seizure, acute confusional states, headache, cranial
nerve palsies, ataxia, nystagmus, papilloedema, meningitis, tremor, cortical
blindness, and coma. There are no specific laboratory or magnetic resonance
imaging findings, making a proper diagnosis often difficult. We report two
cases of cerebral lupus in a thirteen-year-old and ten and a half year old
girl. The first case presenting with fever, headache, right hemi paresis,
aphasia, and somnolence. Neither meningeal signs nor pathologic reflexes were found. CT-scan
revealed a white matter infarction, symmetrical on frontal lobe, midline slight
shift to the left, but cerebral bleeding was not noted. The diagnosis of SLE of
this patient was based on malar rash, oral ulcers, pleuritic pain, neurological
disorders, and positive anti-DNA antibody and ANA test. The second patient had
been diagnosed lupus nephritis since 5 months ago. She was hospitalized because
of dyspnea and behavioral disorder. CT-scan revealed severe brain atrophy. Both patients were treated with
methylprednisolon pulse 30 mg/kg/day for three days and followed with oral
prednisone 2 mg/kg/day. Both of these patients were discharge on good
conditions.
Keywords: Systemic Lupus
Erythematosus, diagnosis, cerebral lupus, brain involvement, prednisolon, prednisone
Author: Raihan, Rizal Altway,
Niniek Soemiarso, Sjaifullah Noer, Ariyanto Harsono, Fatimah Haniman
Journal Code: jpkedokterangg050037
