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Rheumatoid Leptomeningitis: Magnetic Resonance Imaging and Pathologic Findings—A Case Report
Author(s) -
Cianfoni Alessandro,
Falcone Carlo,
Faustini Francesca,
Lauriola Libero,
Imbesi Steven,
Marca Giacomo Della,
Zoli Angelo,
Colosimo Cesare
Publication year - 2010
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/j.1552-6569.2008.00299.x
Subject(s) - medicine , neuroimaging , magnetic resonance imaging , radiology , fluid attenuated inversion recovery , brain biopsy , subarachnoid space , differential diagnosis , rheumatoid arthritis , stereotactic biopsy , diffusion mri , pathology , cerebrospinal fluid , psychiatry
BACKGROUND AND PURPOSE Rheumatoid arthritis (RA) is a chronic inflammatory multisystem disease with articular and extra‐articular manifestations. Intracranial manifestations of RA are rare. Purpose of this article is to report on a rarely described leptomeningeal involvement in RA, and on its neuroimaging features, including diffusion‐weighted imaging (DWI).METHODS The authors describe the case of a 74‐year‐old woman with a 5‐year history of RA presenting with progressive left‐side weakness and hypoesthesia. The patient underwent laboratory investigation and brain contrast‐enhanced MRI, also with DWI, before undergoing brain biopsy.RESULTS Neuroimaging revealed abnormal high T2‐signal in right frontal and parietal lobes, restricted diffusion in the subarachnoid space, and diffuse thick linear leptomeningeal contrast‐enhancement. These findings were interpreted as rheumatoid leptomeningitis, and brain biopsy confirmed this diagnosis.CONCLUSIONS In summary, rheumatoid meningitis is a rare neurological complication of RA, but it should be considered in the proper clinical setting when patient presentation and laboratory results fail to support the other differential diagnostic possibilities proposed by the MR imaging findings.