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NP SLE is still a nosologic mess- I embrace focal NPSLE (APA associated w vascular enhancement, vasculopathy) but the diffuse categories including psychosis, mood, HA etc in the absence of a high predicative biomarker ( we have none) , normal imaging (convectional MRI ) and only non specific perfusion findings on advanced MR techniques or nuclear studies-- needs intense rheum neuroimmunology .collaboration. Agree with starting w CSF and assessing the must rule outs.