Table 3. Diagnostic approach in neuropsychiatric SLE.
LP: lumbar puncture, MRI: magnetic resonance imaging, EMG: electromyography, NCSL nerve conduction study, MS: multiple sclerosis, DM: diabetes mellitus, AchR: acetylcholine receptor, MRA: magnetic resonance arteriography, EEG: electroencephalography, AVM: arteriovenous malformation, MuSK: muscle-specific tyrosine kinase, TIA: transient ischemic attack, LETM: longitudinally extensive transverse myelitis, EKG: echocardiography, GBS: Guillain Barre syndrome, CVA: cerebrovascular accident
| Clinical scenario | Proposed workup | Possible indications |
| Seizures, Acute confusional state | LP, MRI | Exclude infection/malignancy/neurological disease |
| EEG | For seizure confirmation | |
| Additional testing | Serologic testing for infectious workup/microbial cultures | |
| Autonomic disorder, Polyneuropathy | Autonomic testing | Assessment of severity and parts involved |
| NCS, EMG | Neuropathy characterization | |
| Additional testing | Exclude DM/uremic neuropathy/vitamin deficiencies/celiac disease/AchR/exclude infections | |
| Myasthenia gravis, Cranial neuropathy | MRI | Exclude MS/compression of cranial nerves |
| CT | Exclude thyroid disease | |
| Additional testing | Exclude thyroid disease, look for specific antibodies (AchR, MuSK, LRP4) | |
| Aseptic meningitis | LP, MRI | Exclude infection/subarachnoid hemorrhage |
| Additional testing and NSAID use | Infectious workup/cultures | |
| Cerebrovascular disease (TIA/Stroke) | MRI | Exclude infarcts |
| EKG | Excludes cardiac causes (thromboembolic) of CVA | |
| Doppler ultrasonography of carotid arteries | Exclude cardiac (thromboembolic) causes of CVA | |
| MRA/LP | Exclude cerebral vasculitis | |
| Myelopathy, Plexopathy, Movement disorder | MRI brain | Exclude infection/MS/optic neuritis/malignancy |
| MRI spine | Exclude infection/malignancy/AVM, confirm LETM | |
| LP | Exclude infection/oligoclonal bands | |
| Additional testing | Workup for infectious disease/Wilson disease | |
| Psychosis, Cognitive dysfunction | MRI | Exclude infection/infarction/malignancy |
| Additional testing | Exclude DM/thyroid disease/vitamin deficiencies/pheochromocytoma | |
| GBS | MRI spine | Exclude myelopathies |
| Additional testing | Infectious workup |