Bilateral middle cerebellar peduncle infarcts in a patient with systemic lupus erythematosus

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with multiorgan involvement, including the central nervous system. Neuropsychiatric manifestations (NPSLE) are observed in a significant proportion of patients and may include ischemic strokes, often related to antiphospholipid syndrome (APS) or small vessel vasculitis. We report the case of a 38-year-old woman who presented to the emergency department with acute dysarthria and a history of fever. Brain imaging demonstrated multiple subacute ischemic lesions affecting the bilateral middle cerebellar peduncles and frontal regions, and diffuse leukoencephalopathy. Laboratory investigations revealed high-titer antinuclear, anti-dsDNA, anticardiolipin antibodies, and lupus anticoagulant. The overall clinical, radiological, and immunological profile was consistent with neuropsychiatric SLE. The possible underlying causes of ischemic events were antiphospholipid syndrome and small vessel vasculitis. This case highlights the importance of considering NPSLE in the differential diagnosis of diseases involving bilateral middle cerebellar peduncles. Early recognition and therapy of NPSLE are crucial for improving outcomes in this complex clinical scenario.