Multiple mechanisms can cause ischemic stroke in systemic lupus erythematosus (SLE) patients. When a known case of SLE present with an acute ischemic stroke, the decision for offering thrombolytic therapy can be challenging since some of the mechanisms which may have caused the stroke can be a contraindication or a relative contraindication for thrombolytic therapy. Here we present a case where successful intravenous thrombolytic therapy was offered in an SLE patient where a careful history, clinical examination and imaging features were helpful in taking a judicious decision. This is only the third case in the English literature of a known SLE patient being offered thrombolytic therapy.

PURPOSE: The brainstem plays an important role in the control of micturition, and brainstem strokes are known to present with micturition dysfunction. Micturition dysfunction in cases of lateral medullary infarction (LMI) is uncommon, but often manifests as urinary retention. In this study, we investigated the neuro-anatomical correlates of urinary retention in patients with LMI. METHODS: This was a hospital-based retrospective study conducted in the neurology unit of a quaternary-level teaching hospital. Inpatient records from January 2008 to May 2018 were searched using a computerized database. Cases of isolated LMI were identified and those with micturition dysfunction were reviewed. MRI brain images of all patients were viewed, and individual lesions were mapped onto the Montreal Neurological Institute (MNI) space manually using MRIcron. Nonparametric mapping toolbox software was used for voxel-based lesion-symptom analysis. The Liebermeister test was used for statistical analysis, and the resultant statistical map was displayed on the MNI template using MRIcron. RESULTS: During the study period, 31 patients with isolated LMI were identified. Their mean age was 48 years and 28 (90%) were male. Six of these patients (19%) developed micturition dysfunction. All 6 patients had urinary retention and 1 patient each had urge incontinence and overflow incontinence. In patients with LMI, the lateral tegmentum of the medulla showed a significant association with urinary retention. CONCLUSIONS: In patients with isolated LMI, we postulate that disruption of the descending pathway from the pontine micturition centre to the sacral spinal cord at the level of the lateral tegmentum results in urinary retention.
Brain ; Brain Stem ; Hospitals, Teaching ; Humans ; Infarction ; Inpatients ; Magnetic Resonance Imaging ; Male ; Neurology ; Retrospective Studies ; Spinal Cord ; Stroke ; Urinary Incontinence, Urge ; Urinary Retention ; Urination

Subacute sclerosing panencephalitis (SSPE) usually presents insidiously. Acute presentations with a fulminant course can occur. However hyper acute presentations with a non-progressive course have not been reported. Here we describe two cases that had hyper acute presentation with occipital involvement misdiagnosed initially as ischemic infarct. One case remained stable for 4 years and then had a fulminant course and patient succumbed; the other patient continued to remain stable at 2 year follow up. In countries where SSPE is prevalent, it is important to be aware of such a variant of SSPE.