Steroid-Responsive Cerebral Vasculitis in Systemic Lupus Erythematosus with Sulcal Hyperintensities

The clinical manifestations of cerebral lupus vasculitis have a wide spectrum of severity which can result in different prognoses. Therefore, its diagnosis and treatment remain challenging without specific guidelines. A 49-year-old woman with systemic lupus erythematosus presented with transient left side paresthesia and dysarthria lasting 20 minutes. Brain magnetic resonance imaging (MRI) showed a multifocal diffusion restriction and sulcal hyperintensities in the right middle cerebral artery region. Brain magnetic resonance angiography (MRA) showed multifocal steno-occlusive lesions at her intracranial arteries. Because she only showed transient symptoms, aspirin (100 mg/day), atorvastatin (20 mg/day) and an increased dose of prednisolone (5 mg/day to 10 mg/day) were started, on the suspicion of cerebral lupus vasculitis. Brain MRIs/MRAs renormalized after four months without any recurrence. Cerebral lupus vasculitis manifests diverse clinical and neuroimaging characteristics. Although brain image demonstrates devastating features, tailored immune therapy should be selected based on the severity of the patient’s symptoms.