Cerebral rheumatoid vasculitis: a case report

Akrout, R.; Bendjemaa, Samar; Fourati, H.; Ezzeddine, M.; Hachicha, Imene; Mhiri, Chokri; Baklouti, S.

doi:10.1186/1752-1947-6-302

Cited by 19 publications

(9 citation statements)

References 16 publications

(13 reference statements)

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“…5 As for medium vasculitis, cerebral rheumatoid vasculitis (CRV) has been reported as an infrequent complication in RA, and the characteristic feature of CRV is cerebral parenchymal vasculitis in both cerebral hemispheres. 6 However, RA-related arterial dissection of large vessels in the intracranial or cervicothoracic part, like in our case, is poorly reported.…”

Section: Discussionmentioning

confidence: 50%

Intracranial and extracranial multiple arterial dissecting aneurysms in rheumatoid arthritis: A case report

et al. 2020

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Objective We describe a case of intracranial and extracranial multiple arterial dissecting aneurysms in rheumatoid arthritis (RA). Case Presentation A 29-year-old man with a medical history of RA since 18 years of age was admitted to our hospital for vomiting, dysarthria, and conscious disturbance. At 23, he underwent ligation of the left internal carotid artery (ICA) with superficial temporal artery to middle cerebral artery anastomosis because of acute infarct of the left hemisphere caused by arterial dissection of the left ICA. During the current admission, computed tomography (CT) revealed subarachnoid hemorrhage, and digital subtraction angiography (DSA) demonstrated dissecting aneurysms of the left intracranial vertebral artery (VA) and right extracranial VA. We diagnosed him with a ruptured dissecting aneurysm of the left intracranial VA and performed endovascular parent artery occlusion on the left VA. For the right unruptured VA aneurysm, we performed coil embolization simultaneously. At 2 weeks after the endovascular treatment, follow-up DSA revealed that multiple de novo dissecting aneurysms developed on the origin of the left VA and left and right internal thoracic arteries. Those aneurysms were treated with coil embolization. Other remaining aneurysms on the left thyrocervical trunk, right transverse cervical artery, and both common iliac arteries were treated by conservative therapy. While continuing medical treatment for RA, the patient recovered and was discharged to a rehabilitation hospital. Conclusion Considering that RA-induced vasculitis can be a potential risk of vascular complications including multiple arterial dissections, physicians should carefully perform endovascular interventional procedures for patients with long-term RA.

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Section: Discussionmentioning

confidence: 50%

Intracranial and extracranial multiple arterial dissecting aneurysms in rheumatoid arthritis: A case report

et al. 2020

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“…Furthermore, progressive, disseminated neurological symptoms together with multifocal, heterochronous lesions in brain MRI could suggest a diagnosis of ischaemic stroke in the course of rheumatoid vasculitis. Cerebral vasculitis is a rare complication of longstanding, seropositive RA, which may occur as a part of a systemic manifes-tation of vasculitis or less frequently as an isolated involvement of the brain, and is usually asymptomatic with occasional cause of severe, life-threatening progressive and/or diffuse strokes [1,3,4,8,9].…”

Section: Discussionmentioning

confidence: 99%

Encephalomyelitis associated with rheumatoid arthritis: a case report

Acewicz¹,

Wierzba-Bobrowicz²,

Michałowski³

et al. 2021

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Encephalitis/encephalomyelitis in the course of rheumatoid arthritis (RA) remains a matter of debate. We present a case of a patient with encephalomyelitis associated with RA confirmed with post-mortem neuropathological examination. A 68-year-old woman with a long-standing, seropositive history of RA presented progressive disturbances of consciousness. Magnetic resonance imaging (MRI) of the brain and cervical spine revealed an increase of signal intensity on T2-weighted and fluid attenuated inversion recovery (FLAIR) images with corresponding restricted diffusion involving cerebral peduncles, pons, medulla oblongata, and cervical spinal cord and mild contrastenhancement of the right cerebral peduncle. Extensive radiological and laboratory testing, including autoantibodies to paraneoplastic anti-neuronal and neuronal cell surface antigens, were all negative except for elevated rheumatoid factor. Cerebrospinal fluid (CSF) analysis revealed moderate pleocytosis with mononuclear cell predominance, mildly increased protein level, and negative viral PCRs, bacterial cultures, flow cytometry, and neuronal surface antibodies. Despite intensive treatment with corticosteroids, antibiotics, antiviral drugs, and intravenous immunoglobulin the patient died after 3 months of hospitalization. Post-mortem neuropathological examination revealed numerous, disseminated, heterochronous ischaemic lesions, rarely with haemorrhagic transformation, predominantly in the brainstem, and widespread, diffuse microglia and T-cell infiltrations with neuronal loss and astrogliosis, most severe in the frontal and temporal lobes. Mild, perivascular lymphocyte T infiltrations involved particularly small and mediumsized vessels and were associated with brainstem ischaemic lesions. The neuropathological picture confirmed diagnosis of encephalomyelitis, which together with the clinical course suggested association with RA. Concluding, encepha lomyelitis due to RA remains a challenging, controversial entity that needs further research and the establishment of effective diagnostic and treatment guidelines.

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“…Clinically, cerebral vasculitis, present most commonly with chronic progressive headache, focal neurological signs such as paresis/hemiparesis, aphasia, diplopia, dysarthria, ataxia and seizures [7].…”

Section: Structural Brain Changes From the Systemic Inflammatory Processmentioning

confidence: 99%

MRI brain findings in Rheumatoid Arthritis: a review of the literature

Zdravkova

Tsvetkova

Zlatareva

2021

BRJ

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Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder that mainly attacks the joints and leads to early disability. Despite aggressive anti-inflammatory therapy, the risk of systemic complications remains high. Moreover, the rate of premature cardiovascular disease mortality in patients with active RA, as well as the risk for development of non-fatal cardiovascular and cerebrovascular complications is also high. Central nervous system (CNS) involvement is one of the main components of extra-articular manifestations of RA. Brain changes might be caused by systemic inflammatory response or by the drugs used for treatment. Assessment of brain involvement and its relationship to the characteristics of the disease in patients with RA are particularly useful. Early detection of changes without cerebral symptoms and rapid response in acute events are of particular importance. With the increasing use of more imaging modalities magnetic resonance imaging (MRI) has become highly specific, safe and non-invasive diagnostic tool for early detection and monitoring of different pathological processes involving the brain in patients with RA. Understanding MRI imaging findings in brain involvement is important for selecting appropriate treatment and control of disease progression. The aim of this review is to summarize literature data of brain changes in RA and their relationship with systemic inflammation as well as to demonstrate the role of MRI in their assessment.

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Cerebral rheumatoid vasculitis: a case report

Cited by 19 publications

References 16 publications

Intracranial and extracranial multiple arterial dissecting aneurysms in rheumatoid arthritis: A case report

Intracranial and extracranial multiple arterial dissecting aneurysms in rheumatoid arthritis: A case report

Encephalomyelitis associated with rheumatoid arthritis: a case report

MRI brain findings in Rheumatoid Arthritis: a review of the literature

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