Neuropsychiatric Manifestations of Systemic Lupus Erythematosus Quiz
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Multiple Sclerosis and Autoimmune Neurology, Billings Clinic, Billings MT

Assistant Professor of Neurology, Department of Clinical Sciences, Rosalind Franklin University of Science and Medicine, Chicago Medical School, Chicago, IL

DISCLOSURES: None.

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Question 1 of 5

A 68-year-old woman with systemic lupus erythematosus (SLE) treated with prednisone and azathioprine presents with hemiballistic movements in the right arm and leg for the past 3 weeks. It is summertime, and she reports that she had a mild upper respiratory tract infection a month ago; she has not been exposed to antipsychotics.

What initial diagnostic evaluation is indicated, and what is the likely cause of her abnormal movements?

Brain computed tomography (CT) venography; the most likely etiology is dural venous sinus thrombosis

Brain magnetic resonance imaging (MRI) with/without contrast and lumbar puncture with testing of cerebrospinal fluid (CSF) for West Nile IgG/IgM; the most likely etiology is West Nile encephalitis

Brain MRI and catheter angiogram; the most likely etiology is central nervous system (CNS) vasculitis

Brain MRI with/without contrast and MR angiogram of the head/neck and testing for antiphospholipid antibodies (aPLs); the most likely etiology is stroke

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