The aim of this study is to describe the clinical characteristics and outcomes of Systemic lupus erythematosus (SLE) patients with central nervous system (CNS) involvement in our population. Methods: We conducted a retrospective review of the medical records of patients diagnosed with neuropsychiatric lupus (NPSLE) in Singapore General Hospital between Jan 2007 and Oct 2017. Results: The records of eighteen patients were analysed retrospectively. The median age of diagnosis of NPSLE was 33.5

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... rs. The median duration of SLE at the time of the neuropsychiatric manifestations was 4.5 months. Thirty-three percent had NPSLE as the first presentation of SLE. The most frequent clinical presentation was acute confusional state (30.8%) followed by cerebrovascular disease (23.1%) and seizures (19.2%). Seven patients (38.9%) had more than one neuropsychiatric syndrome. The commonest Magnetic Resonance Imaging (MRI) brain abnormality was white matter hyperintensities (61.1%), followed by acute infarcts (33.3%) and cerebral hemorrhage (22.2%). Multi-vessel involvement (3 or more vessels) (55.6%) was observed on magnetic resonance angiography (MRA). Majority of the patients (72.2%) received intravenous methylprednisolone, 66.7% had intravenous cyclophosphamide and 22.2% had rituximab. Twelve patients (66.7%) had clinical improvement and three patients (16.7%) had relapsing courses. There were three deaths from diffuse alveolar hemorrhage and ischaemic heart disease. Conclusion: Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) manifests in a variety of clinical presentations, with NPSLE syndromes being the first presentation of SLE in one third of the patients. Prompt diagnosis and management is essential to improve clinical outcomes.