Rheumatoid meningitis presenting with stroke-like episodes

Bourgeois, Pascale; Rivest, J.; Bocti, Christian

doi:10.1212/wnl.0000000000000366

Cited by 40 publications

(44 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Unilateral meningeal involvement in rheumatoid meningitis is not considered uncommon. 1,2 Some previous cases had presented with stroke-like episodes of abrupt-onset hemiparesis. 1 In contrast, relatively few cases of rheumatoid meningitis show diffuse symmetric meningeal enhancement.…”

Section: Oy-stersmentioning

confidence: 99%

“…1,2 Some previous cases had presented with stroke-like episodes of abrupt-onset hemiparesis. 1 In contrast, relatively few cases of rheumatoid meningitis show diffuse symmetric meningeal enhancement. 2 Brain MRI findings, which demonstrate unilateral meningeal thickening with high signal intensities along the adjacent subarachnoid space on FLAIR images, and bright signals on DWI are helpful to support diagnosis 3,4 ; however, to our knowledge, the diagnostic importance of asymmetry on brain MRI in rheumatoid meningitis has not been systematically evaluated.…”

Section: Oy-stersmentioning

confidence: 99%

See 1 more Smart Citation

Pearls & Oy-sters: Asymmetric meningeal involvement is a common feature of rheumatoid meningitis

et al. 2017

View full text Add to dashboard Cite

Pearls & Oy-sters: Asymmetric meningeal involvement is a common feature of rheumatoid meningitis PEARLS• Rheumatoid meningitis is a rare complication of rheumatoid arthritis that requires a meningeal biopsy for diagnosis.• Asymmetric meningeal involvement is a common, although not pathognomonic, brain MRI finding in rheumatoid meningitis. OY-STERS• Because various immunosuppressants are used for the treatment of rheumatoid arthritis, a thorough investigation to exclude opportunistic infections should be conducted before the diagnosis of rheumatoid meningitis.• Immunoglobulin G4-related disease, granulomatous diseases such as granulomatosis with polyangiitis, neurosarcoidosis, neurosyphilis, and meningeal metastasis are possible considerations in the differential diagnosis of rheumatoid meningitis.CASE REPORT A 65-year-old woman with a 3-year history of rheumatoid arthritis presented with headache, confusion, a decreased level of consciousness, and recurrent left hemiparesis. Her rheumatoid arthritis was well-controlled with oral prednisolone, methotrexate, and leflunomide. Serum levels of rheumatoid factor and anticyclic citrullinated peptide antibody were 69.3 and 48.8 U/mL, respectively. Brain MRI revealed mild hydrocephalus and diffuse asymmetric high signal intensities with patchy nodules, which were prominent along the leptomeninges and subarachnoid space of the right frontoparietal lobe on fluid-attenuated inversion recovery (FLAIR) images and diffusionweighted imaging (DWI). Gadolinium uptake was observed in the leptomeninges over the right hemisphere on postcontrast T1-weighted images (figure 1, A-C). The results of CSF analysis showed an opening pressure of 15 cm H 2 O, leukocyte count of 20/mL (54% neutrophils, 31% lymphocytes, 15% other cells), protein level of 113.4 mg/dL, and glucose level of 43 mg/dL; however, within 2 weeks, the CSF opening pressure became elevated, reaching 27 cm H 2 O. In addition, CSF rheumatoid factor was detected at a level of 17.6 IU/mL. An extensive workup for infectious diseases, autoimmune diseases including vasculitis, and leptomeningeal metastasis was performed. CSF cytology for malignant cells as well as Gram stain and culture were negative. Tests for Mycobacterium tuberculosis and fungus in the CSF were negative. CSF PCR results for Hemophilus influenzae, Streptococcus agalactiae, Neisseria meningitidis, Streptococcus pneumoniae, Listeria monocytogenes, herpes simplex virus, varicella-zoster virus, EpsteinBarr virus, cytomegalovirus, and enterovirus were negative. Serum levels of immunoglobulin G subclass IV (IgG4), antinuclear antibody, anti-neutrophil cytoplasmic antibodies, anti-dsDNA antibody, antiRo/La antibodies, and angiotensin converting enzyme were normal. The EEG results showed regional slowing in the right frontocentral region. A biopsy from the right frontal meninges revealed necrotic granulomatous inflammation with dense infiltration of CD68-positive histiocytes as well as focal vasculitis in the leptomeninges ( figure 1, D-F). Rheumatoid nodules were not...

show abstract

Section: Oy-stersmentioning

confidence: 99%

Section: Oy-stersmentioning

confidence: 99%

Pearls & Oy-sters: Asymmetric meningeal involvement is a common feature of rheumatoid meningitis

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Accelerated atherosclerosis is RA patients due to inflammatory and autoimmune mechanisms increase the risk of stroke [18]. Stroke-like episodes can be also secondary to CNS vasculitis, resulting in acute neurological deficits [53,[57][58][59].…”

Section: Central Nervous Systemmentioning

confidence: 99%

“…RA patients may present with seizures secondary to the disease itself. Potential causes of seizures specifically related to RA are secondary to medication (such as methrotexate and sulphasalazine), vasculitis, rheumatoid arthritis nodules, CNS infections and also associated with antiphospolipid syndrome [55,[57][58][59][60][61][62]. A brain MRI is recommended for identifying a potential etiology for seizure, such as a space occupying lesion, rheumatoid nodules or even a stroke.…”

Section: Central Nervous Systemmentioning

confidence: 99%

“…A brain MRI is recommended for identifying a potential etiology for seizure, such as a space occupying lesion, rheumatoid nodules or even a stroke. In cases of rheumatoid meningitis, the brain MRI can demonstrate high T2 sequence sign lesions with diffuse gadolinium enhancement of the lepto and pachymeninges [58,59]. CSF analysis may present with elevated white cells and normal to slightly elevate proteins.…”

Section: Central Nervous Systemmentioning

confidence: 99%

See 1 more Smart Citation

Neuropsychiatric manifestations in rheumatoid arthritis

Joaquim

Appenzeller

2015

Autoimmunity Reviews

View full text Add to dashboard Cite

Rheumatoid Meningitis Presenting With Multiple Strokelike Episodes

2015

View full text Add to dashboard Cite

cortex (14.2% astrocytes; 4.8% neurons; 325 cells), 6.4% in CA1 (18% astrocytes; 9.6% neurons; 941 cells), 5.7% in caudatum (20% astrocytes; 6.4% neurons; 470 cells), and 5.3% in cerebellum (3.2% astrocytes; 6.0% neurons; 225 cells). Discussion | Greco et al 6 described the presence of inclusions in 11 cases of men with FXTAS aged 67 to 87 years. In our patient, the number of inclusions were in the low range when compared with those cases. In summary, FXTAS is thought to be a disorder of aging in carriers of FMR1 premutation; however, this case documents that FXTAS can occur earlier in adult life, particularly if another disease process is occurring, such as substance abuse, that may exacerbate the pathological process of FXTAS.

show abstract

Rheumatoid meningitis presenting with stroke-like episodes

Cited by 40 publications

References 8 publications

Pearls & Oy-sters: Asymmetric meningeal involvement is a common feature of rheumatoid meningitis

Pearls & Oy-sters: Asymmetric meningeal involvement is a common feature of rheumatoid meningitis

Neuropsychiatric manifestations in rheumatoid arthritis

Rheumatoid Meningitis Presenting With Multiple Strokelike Episodes

Contact Info

Product

Resources

About