Massive vasculitic cerebellar infarction in patient with systemic lupus erythematosus

Fluid-attenuated inversion recovery (FLAIR) brain magnetic resonance imaging (MRI) revealed high signal intensity in the left cerebellum with mass effect and obstructive hydrocephalus [Figure 1]a and b. In addition, diffusion-weighted imaging (DWI) showed restricted diffusion [Figure 1]c and d. However, CT-cerebral angiography did not show any luminal narrowing of the vertebral artery [Figure 1]e. The patient underwent emergency decompressive craniectomy and left cerebellar posterior lobectomy. Pathology of cerebellar lesion revealed parenchymal change with intense microglial infiltration and multiple hemorrhages suggestive of cerebellar infarction [Figure 2]a and b. In addition, vascular change with perivascular and vascular neutrophilic infiltration and massive fibrin leakage was noted, favoring SLE-associated vasculitis [Figure 2]c and d. Patient improved gradually and became alert three weeks after surgery.