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Case report
Moyamoya angiopathy unmasking systemic lupus erythematosus
  1. Shambaditya Das,
  2. Souvik Dubey,
  3. Alak Pandit and
  4. Biman Kanti Ray
  1. Department of Neurology, Institute of Postgraduate Medical Education and Research, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
  1. Correspondence to Dr Souvik Dubey; drsouvik79{at}gmail.com

Abstract

A 47-year-old woman with history of seizure disorder (semiology of seizure unknown), not well controlled with antiepileptic drugs since last 30 years presented with 1-year history of intermittent throbbing headache. On the day prior to admission, she experienced worst headache, followed by loss of consciousness. On regaining consciousness, she had neck pain without any focal neurological deficit, but examination was marked by positive meningeal signs. She had history of oral ulceration, photosensitivity and small joints pain for which no medical consultancy was sought until. Following relevant investigations, this case came out to be moyamoya angiopathy secondary to underlying systemic lupus erythematosus. She was put on immunosuppressive and immunomodulator as per recommendations. Among neurological symptoms, headache improved dramatically without any further seizure recurrence till the 6 months of follow-up.

  • stroke
  • systemic lupus erythematosus
  • headache (including migraines)
  • epilepsy and seizures
  • neuroimaging

http://dx.doi.org/10.1136/bcr-2020-239307

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    Footnotes

    • Contributors SD contributed to conception, literature review and initial drafting of manuscript, carrying out all the necessary investigations, collecting all the relevant data and was directly involved in patient care. SD was involved in supervision of patient’s management, gave expert opinion regarding the case and contributed to editing, critical revision and final approval of the manuscript. He also supervised the entire attempt to report the case. AP gave expert opinion regarding the case, and was involved in critical revision and final approval of the manuscript. BKR contributed to supervision of patient’s management, gave expert opinion regarding the case and contributed to critical revision and final approval of the manuscript. All the authors are in agreement to be accountable for all the aspects of the work in ensuring that query related to its authenticity and accuracy are adequately evaluated and settled.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.