Title Page:Title: Stroke in the Young:  A Case of CNS Vasculitis Secondary to Systemic Lupus ErythematosusAuthors: John Badir1, Justin Thorson2, Emily Barr1, Tamra Ranasinghe31Wake Forest School of Medicine, Winston-Salem, North Carolina2Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina3Departement of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, AZCorresponding Author: John BadirCorresponding Author Affiliation: Wake Forest School of Medicine, Winston-Salem, North CarolinaCorresponding Author’s Mailing Address: 539 Power Plant Circle apartment number 243, Winston-Salem, North Carolina 27101Funding statement: This article has no funding source.Data availability: The data used to support the findings of this study are available from the corresponding author upon request.Conflicts of Interest: Authors have no conflicts of interest to disclose.Acknowledgements: This case was presented at the North Carolina Neurological Society Conference, February 2024 in Greensboro, NC, as a poster presentation by authors John Badir, Justin Thorson, and Tamra Ranasinghe.Introduction:Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organ systems, including the skin, joints, kidneys, and the nervous system. One of the severe complications associated with SLE is an increased risk of cerebrovascular accidents. Strokes in SLE patients can result from a variety of pathophysiological mechanisms. These include traditional cardiovascular risk factors, such as hypertension, hyperlipidemia, and smoking, which are compounded by disease-specific factors 1. The chronic inflammatory state of SLE contributes to accelerated atherosclerosis, which is a significant risk factor for ischemic stroke2. Additionally, SLE patients may have antiphospholipid antibodies, which increase the risk of thrombosis, leading to both ischemic and hemorrhagic strokes.  In the context of SLE, one of the more severe neurological complications is CNS vasculitis3. CNS vasculitis secondary to SLE most commonly affects the endothelium of small vessel arteries through perivascular inflammation in a concentric pattern3. This condition represents an inflammation of the blood vessels within the brain and spinal cord, a manifestation that, while not common, poses a significant risk for stroke in SLE patients4. Our case report highlights a unique case of CNS vasculitis in a patient with active SLE that subsequently caused a stroke. The body of literature on vasculitis secondary to SLE as the cause of cerebrovascular disease is extremely limited, thus this case report addresses an important sparsity in the literature for a disease with a high associated morbidity and mortality.Case history/Examination:46 year-old female with a history of hypertension, hyperlipidemia, hypothyroidism, two prior multifocal infracts, elevated cardiolipin IgM, and migraine without aura who presented with acute onset of left facial numbness and dysarthria with word finding difficulty. Her National Institute of Health Stroke Scale (NIHSS) was 7 with a serum glucose of 88 and a blood pressure of 158/89. CT head demonstrated chronic infarcts in the right parietal and occipitals lobes and no hemorrhage. She arrived at the emergency department within 4.5 hours of symptom onset and given the concerns for an acute ischemic stroke, she received IV Tenecteplase.