Kaposi 1 in his original description of systemic lupus erythematosus (S.L.E.), noted recurrent delirium in 2 out of 11 patients. During the past few years there has been a resurgence of interest in the central nervous system manifestations of S.L.E., together with an increasing awareness of their importance. In a recent large prospective study of S.L.E., central nervous system involvement, including psychosis, was seen in 59% of patients and was second only to renal involvement as a cause of death.” The use of sensitive tests for the diagnosis of S.L.E., in particular deoxyribonucleic acid (DNA) antibody titres’ and cerebrospinal fluid complement levels 4 may contribute to a more widespread recognition of this complication. The most difficult diagnostic and therapeutic problems have related to cases where psychiatric symptoms predominate.6 In this review case histories of five patients with central nervous system lupus seen recently at Hammersmith Hospital are reported to illustrate some of the clinical problems.
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