Systemic lupus erythematosus with altered mental status and seizures. Assess for lupus cerebritis.. There is a gyriform area of restricted diffusion, susceptibility artifact, and peripheral enhancement in the right frontal lobe with surrounding vasogenic edema. The lesion is associated with peripheral contrast enhancement that measures up to 25 mm. There is a similar appearing lesion involving the left basal ganglia that measures up to 15 mm. There are also areas of T2 hyperintensity and swelling involving the bilateral thalami, right basal ganglia, and right midbrain. In addition, there are patchy areas of restricted diffusion and T2 hyperintensity without associated enhancement in the bilateral corona radiata and centrum semiovale. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a partially-empty sella. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a subcentimeter right maxillary alveolar cystic lesion, which may represent a periapical or globulomaxillary cyst.
Multifocal focal supratentorial and infratentorial lesions associated with areas of hemorrhage, peripheral enhancement, as well as surrounding vasogenic edema may represent infarcts of varying ages related to lupus vasculitis. Septic emboli from endocarditis (Libman-Sacks) or other infectious process, such as Hurst disease (acute hemorrhagic leukoencephalitis), are alternative considerations. 