title: Vertebrobasilar artery territory infarction as an initial manifestation of systemic lupus erythematosus.
abstract: Cerebral infarction is a well-documented complication of systemic lupus erythematosus (SLE), that usually occurs several years after the diagnosis of SLE. To our knowledge, however, strokes associated with vertebrobasilar artery involvement were not reported to present as an initial manifestation of SLE. We report two patients, who presented with vertebrobasilar territory infarction as an initial manifestation of SLE. Patient 1 was a 16-year-old girl, who developed dysarthria and ataxia. MRI showed multiple infarcts in the pons, cerebellum and thalamus. Four-vessel cerebral angiography showed multifocal stenoses in the vertebral and basilar arteries with beaded appearance. Patient 2 was a 26-year-old woman, who developed headache associated with dysarthria, dizziness and ataxia. MRI showed multiple infarcts in the cerebellum, medulla, pons, midbrain and thalamus. Cerebral angiography revealed occlusion of both vertebral arteries at the first cervical vertebral level with non-visualization of the basilar artery. Both patients were diagnosed as having SLE supported by laboratory results. Although rare, posterior circulation stroke can present as an initial manifestation of SLE, which may be attributed to vasculitis or dissection in the vertebral/basilar artery.
authors.affiliation: Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, South Korea.
authors.forename: S U
authors.initials: SU
authors.lastname: Kwon
authors.forename: J Y
authors.initials: JY
authors.lastname: Koh
authors.forename: J S
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D001933:Brain Stem / Q000098:blood supply* / Q000473:pathology*; D002531:Cerebellum / Q000098:blood supply* / Q000473:pathology*; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D013788:Thalamus / Q000098:blood supply* / Q000473:pathology*; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology*