Midbrain infarct presenting as isolated medial rectus palsy.

The abrupt onset of CNS symptoms in SLE patients presents a diagnostic and therapeutic challenge. As reported on a recent review of 323 SLE patients, the most common CNS presentations in descending order of frequency were headache, cerebrovascular disease, mood disorders, cognitive dysfunction, seizures, psychosis, anxiety disorder, and acute confusional state. [2] These symptoms may be either due to direct immune mediated injury of the CNS or secondary events (i.e., related to complication of SLE or its treatment).