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NPSLE Cerebritis — SCE Rheumatology MCQ

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HardRheumatology EmergenciesNPSLE CerebritisSCE Rheumatology

A woman with SLE and persistent triple-positive antiphospholipid antibodies develops abrupt aphasia and hemiparesis. MRI shows a focal diffusion-restricted infarct; CSF is acellular and there is no seizure, psychosis or diffuse inflammatory MRI change. Which disease attribution should guide treatment?

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Reveal the answer and explanation

Correct answer: D — Treat as APS arterial thrombosis with standard stroke care and secondary antithrombotic therapy

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as D · D = shown as E

C is correct. The abrupt focal deficit and territorial infarct in a persistently triple-positive patient support thrombotic APS, for which secondary antithrombotic therapy is central after ordinary stroke causes are assessed. A and B mistake serology for evidence of inflammatory NPSLE. D does not fit the acellular CSF or imaging. E invents a non-standard attribution requirement. Immunosuppression is reserved for a convincing inflammatory neuropsychiatric mechanism or another lupus indication.

Reference: BSR guideline for adult systemic lupus erythematosus: https://academic.oup.com/rheumatology/article/57/1/14/4318864