Scattered oval and flame shaped areas of abnormal signal are present in the subcortical white matter bilaterally, involving the left frontal lobe, bilateral occipital lobes, and right cerebellum. Abnormal signal is evident in the brainstem as well. Multifocal ischemic foci are a possibility, due to vasculitis or venous thrombosis. Metastatic disease would not likely have this configuration of lesions. Pathologically, there is perivascular inflammation and endothelial cell proliferation.
Occipital involvement is characteristic, with sparing of the periventricular regions.
Other manifestations of CNS lupus include atrophy, infarcts, and hemorrhage. The vasculitic lesions occasionally respond to steroids.