Systemic lupus erythematosus (SLE) is a multisystem, autoimmune connective tissue disorder. Neuropsychiatric SLE (NPSLE) has varied clinical and radiological manifestations. Clinical manifestations range from subtle abnormalities of neurocognitive functions and mood changes to overt psychiatric or neurological manifestations such as seizures, stroke, and psychosis. Magnetic resonance imaging (MRI) may show various types of abnormalities. Cerebral white matter lesions are most common (60-86%). Here, we are discussing a young female who presented with alteration of sensorium and right-sided hemiparesis, and MRI of the brain showed extensive involvement of brainstem in the form of possible demyelination.