Systemic lupus erythematosus: CNS vasculitis
Altered mental status and seizures.
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Axial FLAIR showing multiple patchy areas of hyperintensity at grey-white junction, likely ischemic in origin suggestive of CNS vasculitis.
Rheumatological markers for systemic lupus erythematosus (SLE) were positive and indicated active disease.
Diagnosis of CNS vasculitis was made clinically and the risk of brain biopsy vs trial of steroids was weighed. The patient decided to trial of steroids and immunosuppressants.
After 2 months, the patient showed dramatic improvement clinically and on imaging after treatment with steroids and rituximab.
- Jennekens FG, Kater L. The central nervous system in systemic lupus erythematosus. Part 2. Pathogenetic mechanisms of clinical syndromes: a literature investigation. Rheumatology (Oxford). 2002;41 (6): 619-30. doi:10.1093/rheumatology/41.6.619 - Pubmed citation
- Pomper MG, Miller TJ, Stone JH et-al. CNS vasculitis in autoimmune disease: MR imaging findings and correlation with angiography. AJNR Am J Neuroradiol. 1999;20 (1): 75-85. AJNR Am J Neuroradiol (full text) - Pubmed citation