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Lupus cerebritis

Case contributed by Dr. Ryan Key


New-onset seizures.

Patient Data

Age: 30 years
Gender: Female

Extensive patchy hypodensities throughout the cerebellum. Multifocal cortical and subcortical hypodensities in the cerebral hemispheres. 


Innumerable subacute lacunar infarcts scattered throughout the cerebellum, and a subacute lacunar infarct in the superior aspect of the right thalamus. Extensive oedema in the cortex and subcortical white matter of the cerebral hemispheres, cerebellum, and pons. Moderate narrowing of the supraclinoid ICAs and carotid termini, and questionable mild focal narrowing of the middle of the basilar artery. Findings are most consistent with a cerebritis/encephalitis and vasculitis. Differential considerations include inflammatory/autoimmune cerebritis/vasculitis or infectious meningoencephalitis. Superimposed PRES and/or seizure-related changes may contribute to the oedema, although some atypical features make them unlikely to be the primary pathologic process. 

Case Discussion

The patient was diagnosed with lupus cerebritis and lupus CNS vasculitis. She had a history of lupus and lupus nephritis, resulting in end-stage renal disease and the need for hemodialysis. She presented with new-onset generalised seizures. High-dose steroids were given for the cerebral oedema. Lumbar puncture performed after oedema subsided was significant for a lymphocytosis and oligoclonal bands, nonspecific findings which can be seen with lupus cerebritis 1. CSF and blood bacterial, viral, and fungal studies were negative. 

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Case information

rID: 58644
Published: 28th Feb 2018
Last edited: 12th Apr 2020
Inclusion in quiz mode: Included

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