Systemic lupus erythematosus, antiphospholipid syndrome: focus on nervous system lesions

Systemic lupus erythematosus and antiphospholipid syndrome are two rare and complex diseases that can affect various organs and systems of the human body. Systemic lupus erythematosus is the prototype of connective tissue diseases that can present with a full spectrum of neurological and mental disorders. It is quite difficult to establish an accurate etiological diagnosis of systemic lupus erythematosus with predominant neuropsychiatric symptoms. The exact timing of neurological manifestations remains controversial: either the central nervous system is the initial target of autoimmune disorders, or neurological symptoms are part of a multisystem lesion. Antiphospholipid syndrome is a prothrombotic systemic autoimmune disease with heterogeneous clinical and pathological manifestations and is a well-established cause of ischemic stroke and transient ischemic attack, especially in young patients. There is growing recognition of a broader spectrum of cerebrovascular lesions associated with antiphospholipid syndrome, including white matter hyperintensities, cortical atrophy, and lacunar infarcts, which may have clinically important neurocognitive consequences. The article provides a review of the literature examining the spectrum of neurological disorders in patients with antiphospholipid syndrome and the inflammatory and cytokine mechanisms that play an important role in the pathogenesis of nervous system damage in systemic lupus erythematosus.