Acute Ischemic Stroke as the Initial Presentation of Primary Sjögren's Syndrome: A Case Report.

Sjögren's syndrome is a long-standing autoimmune condition that predominantly affects the body's exocrine glands, most notably the eyes and mouth, leading to ocular and oral dryness. Neurological involvement, particularly affecting the central nervous system, is infrequently encountered, and the occurrence of stroke as an initial clinical manifestation remains exceptionally uncommon. We report a 42-year-old diabetic male who presented with an acute onset of right hemiplegia and aphasia, and was subsequently diagnosed with primary Sjögren's syndrome. Evaluation revealed multiple acute infarcts in the left middle cerebral artery territory with apical clot and ischemic heart disease. Positive antinuclear antibody by immunofluorescence, Ro-52 recombinant antibody positivity, and raised inflammatory markers suggested an autoimmune vasculitic process secondary to Sjögren's syndrome. The patient improved significantly after pulse methylprednisolone and hydroxychloroquine therapy. This case highlights the importance of considering autoimmune etiologies like Sjögren's syndrome in young stroke patients with systemic features.