New diagnosis lupus, on steroids, with hallucinations and change in mental status. MRI: There is cortical and subcortical swelling and T2 hyperintensity in the bilateral frontal, parietal, and occipital lobes along watershed zones without restricted diffusion. There is prominence of leptomeningeal vessels in the affected regions. There is also mild periventricular white matter T2 hyperintense surrounding the posterior portions of the bilateral lateral ventricles. The infratentorial contents are unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is nonspecific patchy enhancement within the oral tongue.MRA: There is no evidence of large vessel significant steno-occlusive arterial lesions or aneurysms.MRV: There is no evidence of venous sinus thrombosis.
1. Cortical and subcortical swelling and T2 hyperintensity in the bilateral frontal, parietal, and occipital lobes along watershed zones is most suggestive of posterior reversible encephalopathy syndrome, without associated hemorrhage or acute infarction.2. No evidence of large vessel significant steno-occlusive arterial lesions.3. No evidence of venous sinus thrombosis.REFERENCES: 1. Kur JK, Esdaile JM. Posterior reversible encephalopathy syndrome--an underrecognized manifestation of systemic lupus erythematosus. J Rheumatol. 2006 Nov;33(11):2178-83. 2. Leroux G, Sellam J, Costedoat-Chalumeau N, Le Thi Huong D, Combes A, Tieulié N, Haroche J, Amoura Z, Nieszkowska A, Chastre J, Dormont D, Piette JC. Posterior reversible encephalopathy syndrome during systemic lupus erythematosus: four new cases and review of the literature. Lupus. 2008 Feb;17(2):139-47. 