Intravenous thrombolysis in SLE-related stroke: a case report and literature review

Patients with systemic lupus erythematosus (SLE) bear an increased risk of ischemic stroke. However, evidences for treating acute stroke due to artery thrombosis in SLE patients are extremely limited. A 45-year-old woman experienced sudden left hemiplegia. She was transported to the emergency department of our hospital 2 hours after the initial symptom. According to the medical records, the patient was diagnosed with SLE at the age of 28. CT scanned 150 min after the initial symptom showed no evidence of acute changes or hemorrhage. Magnetic resonance angiography (MRA) revealed occlusion of the right proximal middle cerebral artery (MCA). Ischemic stroke was diagnosed and NIHSS scored 11. The occluded MCA was successfully recanalized with intravenous rtPA. Sequent vascular imaging and serological results indicated that the etiology of the occlusion in right MCA was SLE vasculitis. The patient attained a mRS of 3 at the 3-month follow-up. The case is the first one in the literature that acute ischemic stroke related to SLE vasculitis was treated successfully with intravenous rtPA thrombolysis. The feasibility of intravenous thrombolysis for stroke related to SLE warrant further study.