Swallowing disturbance due to isolated vagus nerve involvement in systemic lupus erythematosus.

Neuropsychiatric lupus is a well-recognized complication of systemic lupus erythematosus (SLE) and encompasses a wide variety of neurological manifestations. Although isolated cranial nerve involvement is rare, it can cause significant morbidity and disability. This report describes a case with isolated vagus nerve involvement as the principal sign of central nervous system involvement. A 30-year-old female with SLE had one short course of lupus-associated psychosis in December 2001. In August 2002, the patient suffered from progressive swallowing difficulty, developed a transient episode of hypercapnic respiratory failure and required nasogastric tube feeding due to isolated vagus nerve involvement. Magnetic resonance imaging revealed a subtle but distinct brainstem lesion over the ponto-medullary junction, near the location of the vagus nerve nuclei. The patient completely recovered three weeks later following treatment with intravenous dexamethasone. This report also discusses the differential diagnosis of this rare condition.