Neuropsychiatric complications of autoimmune diseases

1. Big picture

Autoimmune diseases can affect the nervous system at almost every level: brain, meninges, spinal cord, nerve roots, peripheral nerves, autonomic nerves, neuromuscular junction, and muscle. They can also present with psychiatric symptoms such as confusion, psychosis, mood change, personality change, cognitive decline, or delirium.

For the exam, the key idea is:

Autoimmune neurological disease is often subacute, multifocal, fluctuating, inflammatory, and potentially treatable.

The most important clinical danger is misdiagnosis. A young woman with stroke-like symptoms, seizures, psychosis, headache, or cognitive change may not have a primary psychiatric disease: she may have systemic lupus erythematosus (SLE), antiphospholipid syndrome, vasculitis, autoimmune encephalitis, neurosarcoidosis, Behçet disease, or another immune-mediated disorder.

The safest exam approach:

In unexplained neuropsychiatric symptoms, especially in young patients or patients with systemic inflammatory signs, think of autoimmune disease and look for evidence of systemic involvement.

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