J Korean Soc Radiol.  2021 Sep;82(5):1281-1286. 10.3348/jksr.2021.0039.

A Case Report of Pontine Infarction as an Initial Manifestation of Systemic Lupus Erythematosus: Diagnostic Clues from MRI and Digital Subtraction Angiography

• Chung MS
• Byun JS
• Yim Y

• KMID: 2520708
• DOI: http://doi.org/10.3348/jksr.2021.0039

Abstract

Brainstem infarction due to vertebrobasilar insufficiency is a rare initial presentation of systemic lupus erythematosus (SLE) patients and small-vessel dissection as the direct cause of infarction has not been reported. We report the case of a 20-year-old female with acute infarction on the right side of the pons due to a small artery (pontine perforator) dissection, identified on digital subtraction angiography and high-resolution vessel wall MRI (vwMRI). She was diagnosed with SLE based on the presence of neurologic disorders and relevant laboratory findings. The pontine perforator-dissecting aneurysm had occluded and the right distal vertebral artery had resolved on subsequent vwMRI. She had a modified Rankin Scale (mRS) score of 1 at discharge with mild symptom improvement, and exhibited no further aggravation of symptoms at 3 or 12 months, maintaining an mRS score of 1.

Keyword

Stroke; Systemic Lupus Erythematosus; Dissecting Aneurysm; Magnetic Resonance Imaging; Digital Subtraction Angiography