Ischemic lesion in systemic lupus erythematosus

Clinical history
This 61-year-old female presented with a rapidly progressing paresis of both upper limbs and tingling in both hands. Clinical history mentions a diagnosis of systemic lupus erythematosus already made in 1967. In 1990, the patient had a first episode of transverse myelitis with a sensitive level of Th3 and spastic paraparesis from which she recovered only partially. Presently, a new episode of transverse myelitis is clinically suspected affecting the C2-C6 level.

MRI findings
Image 1: Sagittal T1WI. Mild enlargement of the cervical cord with ill defined low signal intensity area at the level of C4-C6.
Image 2: Sagittal T2WI. Sagittal T2 WI show high signal intensity extending from the upper cervical cord to Th1.
Image 3: Sagittal Gd T1WI show patchy enhancement predominant at the C3-C6.
Image 4: Axial GdT1WI confirm central contrast uptake in the cervical cord.
Image5: Axial T2WI show a centromedullary high signal intensity area.

Conclusion
Acute ischemic lesion of the cervical cord in a patient with systemic lupus erythematosus.

Comments
Ischemic lesions of the CNS are typically observed in patients with SLE and closely linked to an antiphospholipid antibody syndrome like it was well documented clinically in this patient.

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