Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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November 16, 2015
Systemic Lupus Erythematosus-associated Optic Neuritis and Acute Infarction
- Background:
- Optic neuritis is an uncommon neurologic manifestation of systemic lupus erythematosus (SLE) and can be seen in about 1% of lupus patients, whereas strokes have been reported in up to 20% of patients with SLE.
- Clinical Presentation:
- Neuropsychiatric manifestations such as seizures, headache, and cognitive and behavioral impairment are the most common CNS manifestations of lupus.
- Optic nerve involvement is rare and may lead to variable degrees of vision loss.
- Key Diagnostic Features:
- Most common MRI findings in SLE include white matter hyperintensities on T2 and FLAIR sequences.
- Acute infarcts can be seen in patients with increased antiphospholipid antibodies.
- Optic neuritis is a rare manifestation of SLE.
- Patients with vasculitis can demonstrate beading of intracranial vasculature and punctate enhancement in the basal ganglia, brain stem, and subcortical white matter.
- Differential Diagnosis:
- Multiple sclerosis
- Neuromyelitis optica
- Ischemic optic neuritis
- Lyme disease
- Sarcoidosis
- Neurosyphilis
- Treatment: Steroids, cyclophosphamide, hyrdroxychloroquine
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