INTRODUCTIONSCI is a rare disease that widely varies in its clinical presentations and vertebral artery dissection can be seen in 4% to 10% of SCI. These has left patients with harmful neurological outcomes, such as paraplegia, quadriplegia, and urinary incontinence [1,2,4]. The spinal cord receives a vascular supply which consists of two arterial systems that form a rich anastomotic network, the single anterior spinal artery and paired posterior spinal arteries in which the former supplies the anterolateral two-thirds of the spinal cord, and the latter supplying the posterior one-third of the spinal cord making the spinal cord relatively resistant to ischemia [3]. SCI develops when the vascular supply to the spinal cord fails and typical causes of infarct include nonprocedural and procedural etiologies such as cardio-embolism, fibrocartilaginous embolism, arterial dissections and systemic hypotension but can also develop as a complication after endovascular, aortic or vertebral artery procedures [3]. Subarachnoid hemorrhage (SAH) complication secondary to arterial dissection can be associated with trauma or spontaneously while artery-to-artery embolic events are the most common mechanism of stroke, followed by hemodynamic failure [4]. The cause of the aneurysm could be a combination of vasculitic weakening of the vessel wall from pro-inflammatory manifestations of SLE and possible dilation of the vertebral artery. The following case report serves to illustrate the key points of this condition and discuss the possible mechanisms leading to the SCI and subarachnoid hemorrhage in patients with SLE.