Rheumatoid meningitis can present MRI findings that mimic chronic subdural haematoma

Yagita, Kaoru; Shinde, Akiyo; Suenaga, Toshihiko

doi:10.1136/bcr-2019-229642

Cited by 7 publications

(3 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Neurological manifestations vary widely, and diagnosis remains a challenge because RM mimics many other conditions; hence, RM is another 'great mimicker' in neurology. This entity can present and/or has been misdiagnosed as subdural empyema 1 , subdural haematoma 2 , unsteady gait and falls 3 , sudden-onset focal brain dysfunction and/or stroke [4][5][6][7][8][9][10] , relapsing-remitting signs 11 , headache 5,[12][13][14] , acute neuropsychiatric disorders and confusion 8,[15][16][17][18][19] , seizures 13,[20][21][22] , epilepsy 23,24 , parkinsonism 25,26 , and granuloma of the meninges 27 .…”

mentioning

confidence: 99%

Rheumatoid meningitis: report of two cases

Guevara

Villa

Nunez³

et al. 2021

Rev. méd. Chile

View full text Add to dashboard Cite

Rheumatoid meningitis (RM) is a rare complication of rheumatoid arthritis (RA). RM mimics many other conditions such as subdural empyema, unsteady gait, focal brain dysfunction, stroke, relapsing-remitting motor signs, headache, neuropsychiatric disorders, seizures, parkinsonism, and meningeal tumors. RM is considered a disease with poor prognosis. However, cases reported in the last decade show a good outcome. We report two cases with a favorable outcome. A 48-year-old man with a three-year history of RA admitted for headache, sensory disturbances, and speech difficulties. Brain magnetic resonance imaging (MRI) showed a left parietal subdural laminar lesion with restricted diffusion and a small left superior frontal acute infarction. A subdural empyema was originally suspected, and antimicrobials were prescribed. A follow-up MRI did not show progression of the subdural lesion and the patient was discharged 14 days after admission without focal deficits. A 44-year-old female patient with two years of seronegative RA was admitted for severe headache, confusion, nausea and vomiting. Brain MRI showed subtle supra and infratentorial leptomeningeal involvement and a left cerebellar acute infarct. A meningoencephalitis due to etanercept was initially thought and treated with dexamethasone. The patient was discharged but had to be admitted again and a new MRI showed a progression of the leptomeningeal involvement. She worsened and required endotracheal intubation. Cyclophosphamide was started and the patient became asymptomatic three months later. We propose that treatment should not be delayed waiting a biopsy when a diagnosis of RM is made and after a cerebrospinal fluid infection has been ruled out.

show abstract

mentioning

confidence: 99%

Rheumatoid meningitis: report of two cases

Guevara

Villa

Nunez³

et al. 2021

Rev. méd. Chile

View full text Add to dashboard Cite

show abstract

“…In contrast, changes in mental status, ataxia, seizures or paresis are more frequently observed in leptomeningitis [22]. Extrameningeal involvement was also found, predominantly as subdural collections, parenchymal oedema and subdural haematoma [23]; however, hydrocephalus, sinus thrombosis [24], ischaemic lesions, as well as enhancement of the tentorium, falx, posterior fossa and optic nerve have also been reported [25]. Diffusion‐weighted imaging is useful in RM diagnosis, showing a bright signal in the subdural and subarachnoid spaces related to a viscous exudate [26].…”

Section: Discussionmentioning

confidence: 99%

Rheumatoid meningitis: A systematic review and meta‐analysis

Villa

Sarquis

Grazia

et al. 2021

Euro J of Neurology

View full text Add to dashboard Cite

Rheumatoid arthritis (RA) is a systemic inflammatory disease that commonly presents with inflammation and pain in the joints but may also cause extra-articular manifestations affecting different organs, including the central nervous system (CNS). Neurological manifestations have been classically classified in CNS vasculitis, rheumatoid nodules (RNs) and rheumatoid meningitis (RM) [1,2]. RM was first

show abstract

“…Cervical myelopathy due to atlanto-axial subluxation is the most well-known CNS manifestation in the course of RA, others include spinal cord compression, subdural hematoma [11], cerebral vasculitis, rheumatoid nodule formation and pachymeningitis [12]. The first suggestion of pachymeningitis due to RA was by Wells [13] in 1969, since then there have been a number of reviews and reports which showed CNS involvement in RA patients.…”

Section: Discussionmentioning

confidence: 99%

Rheumatoid arthritis with pachymeningitis – a case presentation and review of the literature

Joshi¹,

Masiak²,

Zdrojewski³

2020

Reumatologia

View full text Add to dashboard Cite

Rheumatoid meningitis (RM) is a rare central nervous system (CNS) manifestation of rheumatoid arthritis (RA) with a wide spectrum of symptoms. We present a review of the literature with a rare illustrative case of a 61-year-old man with a history of seropositive rheumatoid arthritis (RA) who presented headaches, stroke-like symptoms and seizures. MRI revealed the leptomeningeal enhancement in the right hemisphere. As cerebromeningeal fluid showed increased level of protein and was positive for Candida mannan, the initial clinical diagnosis was fungal meningitis. Despite the antifungal treatment the patient's clinical condition did not improve. Detailed laboratory, radiologic and histopathological diagnostics enabled the diagnosis of RM. In conclusion is worth to highlight that presentation of RM is variable and complex, diagnosing it is a big dilemma which is why it must be considered in the differential in a patient with long-standing seropositive RA.

show abstract

Rheumatoid meningitis can present MRI findings that mimic chronic subdural haematoma

Cited by 7 publications

References 12 publications

Rheumatoid meningitis: report of two cases

Rheumatoid meningitis: report of two cases

Rheumatoid meningitis: A systematic review and meta‐analysis

Rheumatoid arthritis with pachymeningitis – a case presentation and review of the literature

Contact Info

Product

Resources

About