An unusual presentation of rheumatoid meningitis.
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.
Chowdhry
Vaidehi
V
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Kumar
Neeraj
N
Lachance
Daniel H
DH
Salomao
Diva R
DR
Luthra
Harvinder S
HS
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