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Published on: September 19, 2019
A case of SLE presenting stroke-like symptoms
Koji Ishitsuka1, Tetsuro Ago, Kenji Fukuda
1Division of Cerebrovascular Disorders, St. Mary's Hospital, Japan.
Internal Medicine (Tokyo, Japan)
|February 18, 2011
Summary
Systemic lupus erythematosus (SLE) can cause stroke-like symptoms due to small vessel vasculopathies. This case highlights atypical MRI findings in SLE patients presenting with neurological deficits.
Area of Science:
- Neurology
- Rheumatology
- Radiology
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease with diverse clinical manifestations.
- Neurological complications in SLE are common but can present atypically.
- Cerebrovascular events are a known risk in SLE patients.
Observation:
- A 50-year-old woman with SLE presented with stroke-like symptoms: altered consciousness and left hemiparesis.
- Cerebral MRI revealed atypical findings: diffusion-weighted imaging showed high-intensity areas, but these were iso-intense on ADC maps.
- No large artery stenosis was identified on imaging.
Findings:
- Single-photon emission computed tomography (SPECT) demonstrated significantly reduced cerebral blood flow in the affected right fronto-parietal regions.
- The imaging findings were inconsistent with a typical ischemic stroke.
- The observed pattern suggests a microvascular etiology.
Implications:
- Unilateral small vessel vasculopathies may manifest as "stroke-like" episodes in SLE.
- This case underscores the importance of considering vasculopathy in SLE patients with atypical stroke presentations.
- Advanced neuroimaging is crucial for accurate diagnosis and management of neurological SLE complications.
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