Infarction of the posterior limb of the internal capsule: The first clinical manifestation of lupus

Abstract

Isolated cerebral infarction in a small vascular territory such as the posterior limb of the internal capsule rarely represents the first clinical manifestation of systemic lupus erythematosus, and represents a diagnostic challenge, especially if other organ systems are not affected. We report the case of a 28-year-old woman who was admitted to the emergency room with acute onset left-sided hemiparesis. She was diagnosed with acute ischaemic stroke and treated with intravenous thrombolysis, without improvement. The localisation of the lesion in the posterior limb of the internal capsule was based on MRI with DWI sequences, performed after thrombolysis. After extensive workup, a diagnosis of lupus was established. The functional outcome was unfavourable. AChA territory infarction is a special entity, which is increasingly recognised owing to extensive use of MRI in stroke care, with particular clinical characteristics. Cerebrovascular events can be the first clinical manifestation of lupus and contribute to premature morbidity and disability.

Keywords

• cerebral infarction
• systemic lupus erythematosus
• hemiparesis
• thrombolysis
• vasculitis