Unusual Cerebral Involvement of Rheumatoid Arthritis Mimicking a Tumor

Abstract

Background: The central nervous system’s involvement in Rheumatoid Arthritis (RA) is infrequent and can be life-threatening. Mass-like CNS involvement is an unusual presentation. A 45 year old man had suffered seropositive rheumatoid arthritis for five years referred to our hospital with one-week history of right-sided facial paralysis, left hemiparesis and headache. Discussion: MRI demonstrated hyperintense mass-like lesion extended from mesencephalon to right hippocampus and basal ganglia on T2 and FLAIR images. On DWI, restricted diffusion was not present. After contrast administration, minimal contrast enhancement was noted. After methotrexate and steroid treatment, the size had been markedly shrunken on the follow-up images. The clinical symptoms were also improved. Conclusion: To our knowledge, the mass-like presentation was not reported in the literature. We report an unusual case of brain involvement of rheumatoid arthritis mimicked tumor

Intracranial rheumatoid nodule causing recurrent transient neurological deficits

“…Most patients with rheumatoid nodules in the brain are asymptomatic16 and there is only one previous report of a rheumatoid nodule in the brain presenting as a mass-like lesion. This was a 45-year-old man with a 5-year history of seropositive rheumatoid arthritis who presented with a 1-week history of right-sided facial paralysis, left hemiparesis and headache; his MR scan of brain showed a T2/fluid attenuated inversion recovery (FLAIR) hyperintense mass-like lesion extending from the mesencephalon to right hippocampus and basal ganglia 17. His symptoms improved with methotrexate and corticosteroids 16.…”