Unexpected Strikes: Sjögren Syndrome Triggering Multiple Evolving Cerebral Strokes in a Young Patient

Neurological complications are observed less frequently with primary Sjögren syndrome (SS). The central nervous system (CNS) has seldom been shown to exhibit symptoms of SS, making the diagnosis of SS with neurological involvement difficult. We present a rare case scenario in which a young 23-year-old male presenting with an acute history of fever, headache, vomiting, altered sensorium, and seizures was admitted and diagnosed as a sub-acute infarct in the right frontal-parietal-temporal lobes on a computed tomography (CT) scan. Upon further examination, laboratory investigations were suggestive of viral encephalitis. The patient was treated accordingly with antiviral drugs, and the patient improved. The patient took "discharge against medical advice" after 12 days, only to return to the hospital with similar complaints within 15 days. Magnetic resonance imaging (MRI) was done, which suggested an acute evolving infarct in the right frontal and parietal lobe, and further evaluation yielded a diagnosis of SS. The patient was treated with high-dose steroids for seven days. A repeat MRI showed new acute infarcts with dilatation of the ventricular system with periventricular ooze. The patient could not be revived and succumbed after one week of steroid therapy.