Brain atrophy after cortical hyperintensities in systemic lupus erythematosus

Abstract

A 29-year-old woman with systemic lupus erythematosus (SLE) developed seizures, renal failure and coma. Neurological examination was unremarkable; eletroencephalogram and spinal fluid analysis were normal, anti-DNA antibodies were positive. Brain MRI disclosed cortical hyperintensities (Figure). She received metylprednisolone and cyclophosphamide with no improvement, but recovered consciousness after plasmapheresis.She evolved with psychosis, cognitive complaints and follow-up MRI disclosed brain atrophy. Positive anti-DNA antibody, plasmapheresis response and selective grey matter involvement suggest that cortical hyperintensities were secondary to an immune response against neuronal components rather than postseizures changes or vasculitis