**6.2 SLE**

Global structural disintegration could occur in association with CNS involvement due to SLE [67]. Headache, seizure, psychiatric changes, and a wide range of other neurologic complaints could ensue [68]. Dysphagia in SLE is mostly the result of local pathologies (esophageal motility disorder, concomitant gastroesophageal reflux disorder, and esophagitis) [69], but with CNS involvement, neurogenic dysphagia is not unexpected.

## **6.3 Sjogren's syndrome**

Xerostomia and xerophthalmia are hallmarks of the disease. Associated neuropathies [70], optic neuritis, and associated NMOSD [71] are reported. Gastrointestinal manifestations are diverse and various causes could be encountered; of which local pathologies dominate [72] (like SLE). However, CNS involvement should be in mind when facing difficult swallowing complaints.

## **6.4 Neurosarcoidosis**

Sarcoidosis is known to cause noncaseating granulomata and mediastinal lymphadenopathy. Neurosarcoidosis may be present in 5–16% of cases. It could involve any part of the CNS. This differential should be considered whenever confronting inflammatory lesions of the nervous system. However, some symptoms are considered more specific to neurosarcoidosis like bifacial paresis (especially in the presence of uveitis and parotiditis), pituitary/hypothalamus lesions, longitudinally extensive myelitis, and cauda equina syndrome [73].

Deglutition problems are not frequent in sarcoidosis. The most common cause of dysphagia in these patients is the compressive effect of enlarged lymph nodes. Less commonly there is direct esophageal pathology. Neurosarcoidosis is a rare cause of dysphagia. Still, there are cases with dysphagia as a presenting symptom of the disease [74, 75].
