20-year-old female patient with history of systemic lupus erythematosus on corticosteroid treatment. Currently she complains of headache and seizures.

MRI exam of the brain revealed bilateral high frontal and left high parietal multifocal regions of increased signal intensity and diffusion restriction involving the cerebral cortex,subcortical and gray–white matter interface consistent with small infarcts, impressive of CNS vasculitis. Diffuse cerebral atrophy.

Central nervous system  vasculitis occurs as part of a systemic vasculitis.

When the cerebral symptoms are part of a systemic disorder, the diagnosis may be easier, unless the cerebral symptoms are the first or only manifestations

Radiologic findings in systemic lupus CNS vasculitis include:

• small focal areas of hyperintensityat FLAIR and T2 WI are seen in the subcortical and periventricular white matter
• cerebral atrophy.
• intracranial hemorrhage (parenchymal or subarachnoid hemorrhage, subdural hematoma, petechial hemorrhage, or hemorrhagic infarcts)