Brain atrophy after cortical hyperintensities in systemic lupus erythematosus.

A 29-year-old woman with systemic lupus erythematosus (SLE) developed seizures, renal failure and coma. Neurological examination was unremarkable; eletroencephalogram and spi-nal fluid analysis were normal, anti-DNA antibodies were posi-tive. Brain MRI disclosed cortical hyperintensities (Figure). She received metylprednisolone and cyclophosphamide with no im -provement, but recovered consciousness after plasmapheresis. She evolved with psychosis, cognitive complaints and follow-up MRI disclosed brain atrophy. Positive anti-DNA antibody, plas-mapheresis response and selective grey matter involvement suggest that cortical hyperintensities were secondary to an immune response against neuronal components rather than postseizures changes or vasculitis