title: What's in a name?
abstract: A 51-year-old man with rheumatoid arthritis and diabetes mellitus presented with new onset left-sided hemiparesis, left-sided neglect, and left-sided incongruous, denser inferiorly, homonymous hemianopsia. Magnetic resonance image of the brain showed prominent swelling of the right frontal, parietal, and occipital lobes greater than on the left with significant change in the fluid-attenuated inversion recovery signal in the gray matter. Perinuclear antineutrophil cytoplasmic antibodies titers were elevated, and skin biopsy demonstrating leukocytoclastic vasculitis. He showed marked clinical and radiographic improvement in association with recovery of vascular abnormalities after the initiation of prednisone, pulse therapy with methylprednisolone, and methotrexate. Clinicians should be aware of the possibility of neuro-ophthalmic manifestations of rheumatoid arthritis, including rheumatoid arthritis-related vasculitis causing homonymous hemianopsia.
authors.affiliation: Department of Ophthalmology and Visual Sciences, The University of Texas Medical Branch, Galveston, Texas, USA; Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Chia-Kai
authors.initials: CK
authors.lastname: Chu
authors.affiliation: Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Morgan
authors.affiliation: Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Sumayya
authors.initials: S
authors.lastname: Almarzouqi
authors.affiliation: Department of Ophthalmology and Visual Sciences, The University of Texas Medical Branch, Galveston, Texas, USA; Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA; Department of Ophthalmology, Weill Cornell Medical College, Houston, Texas, USA; Department of Neurology, Weill Cornell Medical College, Houston, Texas, USA; Department of Neurosurgery, Weill Cornell Medical College, Houston, Texas, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. Electronic address: AGLee@HoustonMethodist.org.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, University of Virginia Health System, Charlottesville Virginia, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Newman
mesh_terms: D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D003920:Diabetes Mellitus / Q000175:diagnosis; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use; D006423:Hemianopsia / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D020551:Pulse Therapy, Drug; D020293:Vasculitis, Central Nervous System / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D058609:Visual Field Tests; D014794:Visual Fields
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011241:Prednisone; D008775:Methylprednisolone; D008727:Methotrexate
keywords: autoimmune disease; cerebral vasculitis; homonymous hemianopsia; p-ANCA antibodies; rheumatoid arthritis