title: An unusual presentation of rheumatoid meningitis.
abstract: BACKGROUND
  Central nervous system involvement in rheumatoid arthritis can rarely occur in the absence of systemic disease. Rheumatoid meningitis has not been reported to present as spells of neurologic dysfunction.
  
  
  METHODS
  The authors describe a woman with a history of well-controlled rheumatoid arthritis who presented with headaches and spells of focal neurological dysfunction. Brain magnetic resonance imaging, brain biopsy, and temporal artery biopsy were required to make the diagnosis of rheumatoid meningitis with arteritis.
  
  
  RESULTS
  Neuroimaging revealed abnormal leptomeningeal enhancement. Necrotizing granulomatous inflammation was seen on meningeal and brain biopsy. A temporal artery biopsy showed evidence of arteritis without giant cells.
  
  
  CONCLUSIONS
  The possibility of central nervous system involvement by rheumatoid arthritis should be considered in patients with a history of rheumatoid arthritis even in the absence of systemic symptoms. Making the diagnosis may require meningeal and brain biopsy. The condition may be steroid responsive.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Vaidehi
authors.initials: V
authors.lastname: Chowdhry
authors.forename: Neeraj
authors.initials: N
authors.lastname: Kumar
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Lachance
authors.forename: Diva R
authors.initials: DR
authors.lastname: Salomao
authors.forename: Harvinder S
authors.initials: HS
authors.lastname: Luthra
mesh_terms: D000368:Aged; D001167:Arteritis / Q000209:etiology; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001921:Brain / Q000473:pathology*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008581:Meningitis / Q000175:diagnosis / Q000209:etiology*; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology