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Rheumatoid leptomeningitis: radiological alteration of cerebral hypoperfusion and subarachnoid lesions

Ken Ikeda1, Takanori Takazawa, Hirono Ito

  • 1Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan. keni@med.toho-u.ac.jp

Internal Medicine (Tokyo, Japan)
|September 9, 2010
PubMed

Insights

Rheumatoid leptomeningitis (RLM) can cause encephalitis-like symptoms due to inflammation and ischemia. Neuroimaging revealed leptomeningeal lesions and cerebral hypoperfusion, which improved with treatment.

Area of Science:

  • Neurology
  • Immunology
  • Radiology

Background:

  • Rheumatoid arthritis (RA) is a systemic autoimmune disease.
  • Central nervous system (CNS) involvement in RA, such as rheumatoid leptomeningitis (RLM), is rare.
  • RLM can present with diverse neurological deficits.

Observation:

  • A 56-year-old man with RA developed seizures, fever, and emotional lability.
  • Brain MRI showed leptomeningeal lesions, and EEG indicated an epileptogenic focus.
  • Cerebrospinal fluid analysis revealed mild pleocytosis and elevated interleukin-6 levels.

Findings:

  • Brain SPECT demonstrated significant cerebral hypoperfusion in the right hemisphere.
  • Treatment with methylprednisolone and prednisolone led to dramatic improvement in neurological symptoms.
  • Follow-up neuroimaging showed resolution of leptomeningeal lesions and restoration of cerebral blood flow.

Implications:

  • This case highlights the neuroradiological features of RLM, including leptomeningeal enhancement and cerebral hypoperfusion.
  • Leptomeningeal inflammation and adjacent cortical ischemia may underlie the encephalitis-like symptoms in RLM.
  • Early diagnosis and treatment of RLM are crucial for managing CNS complications in rheumatoid arthritis patients.

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