and Purpose-To determine factors associated with ischemic stroke and stroke severity in patients with systemic lupus erythematosus. Methods-Between 1992 and January 2005, 238 consecutive systemic lupus erythematosus patients with no history of stroke were followed-up longitudinally at the Maryland Lupus Clinic. Patients were monitored quarterly for a mean of 8 years after their systemic lupus erythematosus diagnosis, and 44 patients (19%) developed first-ever ischemic stroke. At the end of

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... , Cox proportional regression analyses were used to determine the effect of baseline clinical variables of systemic lupus erythematosus patients in relation to the subsequent occurrence of ischemic stroke and stroke severity after first-ever ischemic strokes. Severe stroke was defined as having a National Institute of Health Stroke Scale Ն6. Results-Severe ischemic strokes occurred in 34 of 44 (77%) patients. Baseline predictors of ischemic strokes and severe ischemic strokes included disease activity, hyperlipidemia, and hypertension. Conclusions-Severe ischemic strokes in systemic lupus erythematosus are not uncommon. Aggressive primary and secondary stroke prevention measures, particularly treatment of hyperlipidemia and hypertension, as well as vigorous treatment of clinical symptoms of active lupus, are needed to prevent serious morbidity and neurological disability. (Stroke. 2007;38:281-285.)