Neuropsychiatric lupus: a mosaic of clinical presentations Shaye Kivity 1,2,5† , Nancy Agmon-Levin 1,5† , Gisele Zandman-Goddard 3,5 , Joab Chapman 4,5  and Yehuda Shoenfeld 1,5,6,7* Abstract Neuropsychiatric symptoms affect nearly half of the patients with systemic lupus erythematosus; however, the effect on disease severity, quality of life, and the prognosis is tremendous. Symptoms of neuropsychiatric systemic lupus erythematosus may range from mild diffuse ones to acute life-threatening events. Although the underlying mechanisms are still largely unravelled, several pathogenic pathways are identified, such as antibody-mediated neurotoxicity, vasculopathy due to anti-phospholipid antibodies and other mechanisms, and cytokine-induced neurotoxicity. The current review describes the old and the new regarding epidemiology, pathophysiology, diagnosis, and management of neuropsychiatric systemic lupus erythematosus. The possible link between neuropsychiatric symptoms and specific mechanis