4. History of Present Illness
2
weeks
Ascending extremity paresthesia
R then L
LE then UE
1
week
1
day
A
No headache, dizziness,
slurring of speech, pain. (+) pruritus, pain
5. History of Present Illness
2
weeks
Ascending extremity paresthesia
R > L
LE > UE
1
week
Ascending extremity weakness
R > L
LE > UE
● Tripping
● Steppage gait
1
day
A
No headache, dizziness,
slurring of speech, pain. (+) pruritus, pain
6. History of Present Illness
2
weeks
Ascending extremity paresthesia
R > L
LE > UE
1
week
● Tripping
● Steppage gait
Legs gave way
(+) Fall
1
day
A
No headache, dizziness,
slurring of speech, pain. (+) pruritus, pain
Ascending extremity weakness
R > L
LE > UE
42. Course in the Wards
HD
1
D
Guillain-Barre
Syndrome
HD
11
HD
5
HD
3
HD
2
HD
4
HD
7
HD
6
HD
8
HD
9
HD
10
43. Course in the Wards
HD
1
D
Guillain-Barre
Syndrome
HD
11
HD
5
HD
3
HD
2
HD
4
HD
7
HD
6
HD
8
HD
9
HD
10
Given IVIg
Deficits fluctuated
(+) fever, pruritus
44. Course in the Wards
HD
1
D
Guillain-Barre
Syndrome
HD
11
HD
5
HD
3
HD
2
HD
4
HD
7
HD
6
HD
8
HD
9
HD
10
Given IVIg
Deficits fluctuated
(+) fever, pruritus
Rheuma: autoimmune workup
(+) Hematuria
Started on HCQ,
prednisone
45. Course in the Wards
HD
1
D
Guillain-Barre
Syndrome
HD
11
HD
5
HD
3
HD
2
HD
4
HD
7
HD
6
HD
8
HD
9
HD
10
Given IVIg
Deficits fluctuated
(+) fever, pruritus
Rheuma: autoimmune workup
(+) Hematuria
Started on HCQ,
prednisone
Cyclo-
phosphamide
47. A patient comes to your clinic complaining of
hematuria. He also admits to joint pains, reduced
appetite, fever and itchy arms. On PE, you note
reddish cheeks and a mouth sore. Your
impression is SLE.
1. What is the first immunologic test to confirm
your impression?
2. The autoantibody above turns out positive. How
will you manage your patient?
49. Enumerate the following autoantibodies:
2. Correlates with disease activity
3. Associated with drug-induced SLE
4. Associated with lupus depression or
psychosis
50. Various autoantibodies are useful
in the SLE workup
Harrison's Principles of Internal Medicine, 19th
Ed.
51. 5. What is the most common presentation of
NPSLE?
6. Give 4 SLICC criteria that permit the
diagnosis of SLE.
52. Headaches are the most common
presentation of NPSLE
62%
18%
8%
5%
5%1%
Headache
Seizures
CVD
Psychosis
Neuropathy
Movement
Muscal and Brey. Neurol. Clin. 28(1) 2010
53. SLE is diagnosed using a set of
clinical and laboratory criteria
Stable VS
Multiple, brown to pink macular patches of varying size ranging 2-3cm on legs, arms and trunk
Normal medical PE
Stable VS
Multiple, brown to pink macular patches of varying size ranging 2-3cm on legs, arms and trunk
Normal medical PE
MMSE: 30
CrN:
Intact
L: 4-5mm BRTL; R: 4-5 BRTL, irregular pupil
Intact
Intact
Sensory deficit on the L, 70-80%
Intact
Left facial hemiparesis
Intact gross hearing
Uvula deviated to the L, weak palatal rise L
No gag
Weak shoulder shrug, L
Tongue deviated to the L
Good bulk and tone
No fasciculations, fibrillations
No spasticity
Left arm drifts
No dysmmetria, no ataxia
No toe extensor
Good bulk and tone
No fasciculations, fibrillations
No spasticity
Left arm drifts
No dysmmetria, no ataxia
No toe extensor
Good bulk and tone
No fasciculations, fibrillations
No spasticity
Left arm drifts
No dysmmetria, no ataxia
No toe extensor
Up to 40% of SLE patients develop neuropsychatric problems called NPSLE
Asymmetry most common: 59%
Distal weakness most common: 34%
The proposed pathophysiologic in NPSLE is microangiopathy affecting nearby nerves. In biopsies, microinfarcts,large infarcts and hemorrhages have been noted.
Hydroxychloroquine 200mg OD
Prednisone 10mg 2tabs BID