Abstract Details

Title A Rare Confluence of Challenges: Lupus Cerebritis with Balint Syndrome Complicated by Spontaneous Subarachnoid Hemorrhage – A Unique Case Report

Topic Autoimmune Neurology

Presentation(s) P8 - Poster Session 8 (5:30 PM-6:30 PM)

Poster/Presentation
Number 14-019

Objective NA

Background Lupus cerebritis, a neuropsychiatric manifestation of systemic lupus erythematosus (SLE), is a systemic autoimmune disease characterized by the production of autoantibodies, resulting in a wide spectrum of clinical manifestations affecting multiple organ systems. Neuropsychiatric involvement, a recognized complication of SLE, has a further distinct subset known as Lupus Cerebritis (LC) that involves inflammation within the CNS and can manifest as cognitive impairment, mood disorders, seizures, and a variety of neurological deficits. Balint syndrome, a rare neurological disorder first described by Rezso Bálint in 1909, is characterized by a triad of symptoms: simultanagnosia, optic ataxia, and oculomotor apraxia. Among the myriad of neurological complications of LC, the coexistence of Balint syndrome is an exceedingly rare and scarcely documented occurrence. Here we present a case with an unexpected twist: the simultaneous presence of spontaneous subarachnoid hemorrhage (SAH), a catastrophic event not commonly associated with lupus cerebritis. and an association that is virtually unprecedented in the literature. The concomitant presence of these three distinct entities presents a diagnostic and therapeutic challenge that demands careful consideration.

Design/Methods NA

Results A 35-year-old female with a history of lupus, seizures, and migraines who had been lost to follow-up presented to the emergency department complaining of a severe headache associated with vomiting. In the ED, she experienced a witnessed generalized tonic-clonic seizure prompting admission for further evaluation. MRI Brain without contrast showed patchy cortical/subcortical T2/FLAIR white matter hyperintensities of the bilateral frontal, parietal, and occipital lobes suspicious for Lupus Cerebritis. On the second day of admission, the patient developed a new onset right-gaze preference and left-sided hemiparesis. Follow-up CTA Head and Neck was concerning for spontaneous subarachnoid hemorrhage. During the hospital course, the patient developed optic ataxia with oculomotor apraxia, simultagnosia, and nystagmus, a constellation of symptoms consistent with Balint Syndrome.

Conclusions NA

Authors/Disclosures
Cesar Jara Silva Acosta, DO (Larkin) PRESENTER	Dr. Jara Silva Acosta has nothing to disclose.
Juliana Cazzaniga	Miss Cazzaniga has nothing to disclose.
Solomon Nittala, DO	Dr. Nittala has nothing to disclose.

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