DIFFERENT CLINICAL MANIFESTATION OF CEREBRAL LUPUS DUE TO DIFFERENT BRAIN INVOLVEMENT. A REPORT OF TWO CASES

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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

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Jp Kedokteran gg 2005