[Systemic lupus erythematosus starting with deterioration of the higher functions of the central nervous system]

The authors report the case of a 42 years-old electrician man, with an 8 months progressive manual difficulties in his specific job, with a complete disability for the last 2 months. These symptoms were associated with anemia, deterioration of the general condition, and slight fever. Three days after the first neuropsychological examination he, suddenly, developed a left hemiparesis. Laboratory investigations confirmed the occurrence of a systemic lupus erythematosus. The neuropsychological examination showed: normal intellectual level with slight memory deficit; severe constructional and ideomotor apraxia; gaze ataxia; optical ataxia; hemisomatoagnosia, anosognosia, and autotopagnosia; agraphia. The authors discuss this particular syndromatic association, remarking the alterations of oculomotor control, the optical ataxia and the role which both may have in the disorganization of gesture activity, concerning also the gnosics disturbances. Furthermore, agraphia is stressed as well as its relation with apraxic disturbances. On the basis of the semiological analysis, the authors come to the conclusion of a bilateral temporo-parieto-occipital involvement.