Fig 1.

A 21-year-old woman with SLE, lupus nephritis, and difficult-to-control hypertension presented with headache and change in vision progressing to generalized seizure. Blood pressure at toxicity was 213/167 mm Hg.

A–D, Brain MR imaging (FLAIR sequence) obtained the day of the toxic event demonstrates extensive holohemispheric pattern with vasogenic edema at the junction between the medial hemispheric (ACA, PCA) and lateral hemispheric (MCA) branches. The pattern outlines the entire supratentorial watershed or borderzone in the frontal (arrows), parietal (curved arrows), occipital (open arrows), and temporal lobes (arrowheads). Vasogenic edema in the frontal lobes extends to the frontal pole region. Diffusion-weighted sequence demonstrated no restricted diffusion.

E, Postcontrast T1-weighted MR image demonstrating prominent cortex and adjacent subcortical white matter edema (arrows) with focal sulcal compression and distortion.