title: An unusual central nervous system involvement in rheumatoid arthritis: combination of pachymeningitis and cerebral vasculitis.
abstract: Severe primary central nervous system (CNS) involvement such as vasculitis and pachymeningitis can rarely occur in rheumatoid arthritis (RA) even in the absence of systemic disease activation. The authors illustrate a female patient with well-controlled RA who presented with headaches, encephalopathy, seizures and relapsing focal neurological deficits. Primary rheumatoid cerebral vasculitis and pachymeningitis were diagnosed based on suggestive brain magnetic resonance (MR) imaging, MR angiography, cerebrospinal fluid analysis and cerebral angiography. MR showed abnormal leptomeningeal enhancement and hyperintense FLAIR signal in the cortical subarachnoid spaces consistent with pachymeningitis. Cerebral angiography findings were consistent with vasculitis. Aggressive treatment resulted in significant clinicoradiological resolution. Cerebral vasculitis is a rare but certain manifestation of RA. This complication can be diagnosed in the presence of suggestive angiographic and CSF findings. The condition may be steroid resistant, and needs to be treated more aggressively.
authors.affiliation: Department of Neurology, Hacettepe University Hospitals, Ankara, Turkey. aokurne@yahoo.com
authors.forename: Asli
authors.initials: A
authors.lastname: Kurne
authors.forename: Rana
authors.initials: R
authors.lastname: Karabudak
authors.forename: Omer
authors.initials: O
authors.lastname: Karadag
authors.forename: Gül
authors.initials: G
authors.lastname: Yalcin-Cakmakli
authors.forename: Kader
authors.initials: K
authors.lastname: Karli-Oguz
authors.forename: Kivilcim
authors.initials: K
authors.lastname: Yavuz
authors.forename: Meral
authors.initials: M
authors.lastname: Calgüneri
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Topcuoglu
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008581:Meningitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D020293:Vasculitis, Central Nervous System / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy