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Rheumatoid cranial pachymeningitis successfully treated with long-term corticosteroid
Yuichiro Ii1, Shigeki Kuzuhara
1Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan. ii-y@clin.medic.mie-u.ac.jp
Rheumatology International
|September 23, 2008
Summary
Rheumatoid cranial pachymeningitis, a rare condition, caused acute nerve palsies in a patient. Long-term corticosteroid treatment proved highly effective for this rheumatoid arthritis complication.
Area of Science:
- Neurology
- Rheumatology
- Pathology
Background:
- Rheumatoid arthritis (RA) can present with rare neurological complications.
- Cranial pachymeningitis, inflammation of the dura mater, is an uncommon manifestation of RA.
Observation:
- A 68-year-old man presented with acute bilateral palsy of the glossopharyngeal (IX) and vagus (X) cranial nerves.
- Cranial MRI confirmed pachymeningitis.
- The patient tested positive for rheumatoid factor (RF) in serum and cerebrospinal fluid (CSF), and anti-agalactosyl IgG antibodies in serum.
- Radiographs showed early signs of rheumatism.
Findings:
- Dural biopsy revealed chronic inflammation with lymphocyte and histiocyte infiltration.
- Diagnosis of rheumatoid cranial pachymeningitis was established.
- The patient had no prior history of rheumatoid arthritis.
Implications:
- This case highlights rheumatoid cranial pachymeningitis as a potential cause of cranial nerve palsies.
- Early diagnosis and treatment with corticosteroids can lead to excellent outcomes.
- Highlights the importance of considering systemic autoimmune diseases in unexplained neurological presentations.
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