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Cerebritis, Lupus, and Lupus Cerebritis
Cerebritis is defined as an inflammation of the cerebrum, a structure associated with memory, speech, etc., as a result of the formation of an abscess within the brain itself, found commonly in patients with lupus.
Systemic lupus erythematosus (SLE) or Lupus is a chronic, autoimmune disease as as a result of the development of autoantibodies that attack the systems and organs in the body.researchers at the indicated that saturated fatty acid palmitate, but not unsaturated oleate, induces the activation of the NLRP3-ASC inflammasome, causing caspase-1, IL-1β and IL-18 production.
Lupus cerebritis is a disorder of nervous system problems (an autoimmune inflammatory disorder) caused by lupus as as a result of the development of autoantibodies that attack the systems and organs in the body. It causes migraine headache, if the duration of the central nervous system involvement last for a few minutes, or causes dementia that can lead to neurological deficits as a transient attacks or permanently.
The Treatment and Management
A. In conventional medicine perspective
Management of central nervous system (CNS) involvement still remains one of the most challenging problems in systemic lupus erythematosus (SLE). In the assessment of the diseases, some researchers suggested that the choice of treatment depends on the most probable underlying pathogenic mechanism and the severity of the presenting neuropsychiatric symptoms. Patients with mild manifestations may need symptomatic treatment only, whereas more severe acute nonthrombotic CNS manifestations may require pulse intravenous cyclophosphamide. Plasmapheresis may also be added in patients with more severe illness refractory to conventional treatment. Recently, the use ofintrathecal methotrexate and dexamethasone has been reported in a small series of patients, with a good outcome in patients with severe CNS manifestations. Anticoagulation is warranted in patients with thrombotic disease, particularly in those with the antiphospholipid syndrome (APS). This article reviews the clinical approach to therapy in patients with CNS lupus(15)
Other suggested that the therapeutic choice depends on accurate diagnosis, identification of underlying pathogenic mechanism, severity of the presentingneuropsychiatric symptoms, and on prompt identification and management of contributing causes of CNS disease. Mild neuropsychiatric manifestations may need symptomatic treatment only. In more severe CNS disease it is important to distinguish between thrombotic and non-thrombotic mechanisms. Focal CNS manifestations, particularly TIA and stroke, are associated with the presence of antiphospholipid antibodies (aPL). Anticoagulation is warranted in patients withthrombotic disease, particularly in those with the antiphospholipid (Hughes) syndrome (APS). Other CNS manifestations, such as demyelinating syndrome, transverse myelitis, chorea, seizures, migraine and/or cognitive dysfunction, when associated with persistent positivity for aPL, may also benefit fromanticoagulation in selected patients. Severe diffuse CNS manifestations, such as acute confusional state, generalised seizures, mood disorders and psychosis, generally require corticosteroids in the first instance. Pulse intravenous cyclophosphamide therapy may help when more severe manifestations are refractory to corticosteroids and other immunosuppressive agents, generally when response is not seen in 3-5 days. Plasmapheresis may also be added in severe cases of symptoms refractory to conventional treatment. Intravenous immunoglobulins, mycophenolate mofetil, rituximab, intratecal methotrexateand dexametasone deserve further studies to confirm their usefulness in the treatment of neuropsychiatric SLE(16)
1. Symptomatic therapy
1.1. Symptomatic therapy is defined as a medical therapy used to treat the symptoms of the disease but not its causes, such as Anti-inflammatory, Analgesic, Antitussives agents, etc.
b. Side effects are not limit to
b.1. Anti-Inflammatory agent (hypertension, skin rash and itching, gastrointestinal discomforts, ulcers and bleeding, kidney damage, etc.
b.2. Analgesics (long-term use of pain relievers can be addictive, stomach irritation, Over doses (2000 mg/day or more) can cause liver damage, etc.
b.3. Antitussives agents (Nausea, vomitin, skin rash and itching, welling, dizziness, etc.
2. Intravenous cyclophosphamide, methotrexate or dexamethasone orimmunoglobulin
a. Depending to the severity of the diseases, medical condition, weight, response to therapy cyclophosphamide or methotrexate or dexamethasone orimmunoglobulin is injection into a vein by your doctor or a healthcare professional.
b. Side effects sre not limit to
b.1. Cyclophosphamide (Nausea, vomiting, loss of appetite, stomach ache, diarrhea, s, temporary hair loss, unusual tiredness or weakness, joint pain, easy bruising/bleeding, etc.)
b.2. Methotrexate (Dizziness, general body discomfort, headache, loss of appetite, mild sore throat, mild stomach pain, nausea, vomiting, tiredness, etc.)
b.3. Dexamethasone (Difficulty sleeping, feeling of a whirling motion, increased appetite and sweating, indigestion; mood swing, nervousness, etc.)
b.4. Immunoglobulin(headache, dermatitis, chills, migraine, dizziness, fever, nausea, vomiting, fatigue , itching, increased Blood Pressure etc.)
3. Immunosuppressive Therapy
a. Immunosuppressive Therapy is defined as the treatment to suppress the immune response to antigen(s), on most cases it is used in conditions such as organ transplantation, autoimmune disease, allergy, etc.
b. Side effects are not limit to
b.2. High blood pressure
b.3. Kidney function.
b.4. Researchers found that Remissions were cyclosporine dependent in 26% of the patients responding to a regimen that included cyclosporine. Clonal or malignant diseases developed in 25% of the patients.(17)
4. Anticoagulant therapy
a. Anticoagulants is also well as blood thinners, used to slow the rate of blood clots of diseases such as thrombosis to atrial fibrillation.
b. Side effects are not limit to
b.3. Easy bruising,
b.4. Increased the risk of bleeding from injuries
b.5. Purplish spots on the skin
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