Neurologic Manifestations of Rheumatologic Disease

This article provides readers with a foundational approach to the diagnosis and treatment of neurologic syndromes that occur in patients with rheumatologic diseases.

Neuroimaging findings such as the central vein sign on MRI to distinguish the white matter lesions of multiple sclerosis from those of systemic lupus erythematosus (SLE), the trident sign on axial postcontrast spine MRI in patients with sarcoid myelopathy, and vessel wall imaging to differentiate central nervous system vasculitis from vasculopathy, can improve diagnostic precision in patients with neurorheumatologic disorders. Treatment of neurologic complications of rheumatologic disease is guided largely by case series but increasingly incorporates targeted therapies such as infliximab for neurosarcoidosis and neuro-Behçet syndrome.

Systemic rheumatologic diseases can cause diverse neurologic symptoms that can be causally related, treatment induced, or comorbid but unrelated. Diagnosis relies on clinical criteria, serology, imaging, and, if these are unrevealing or inconclusive, tissue biopsy.