Resolving MRI lesions in lupus erythematosus selectively involving the brainstem

An adolescent girl with systemic lupus erythematosus presented with selective brainstem dysfunction as the initial sign of central nervous system involvement. Although computed tomography was initially normal, magnetic resonance imaging demonstrated multiple, large brainstem lesions. Serial magnetic resonance imaging, which revealed resolution of most of these lesions, correlated with a good clinical outcome. We postulate that this magnetic resonance imaging pattern represents microinfarction with surrounding edema.