Cerebral vasculitis in rheumatoid arthritis

Area of Science:

• Neurology
• Rheumatology
• Pathology

Background:

• Rheumatoid arthritis (RA) is a systemic autoimmune disease.
• Neurological complications in RA are uncommon but can be severe.
• Cerebral vasculitis is a rare manifestation of rheumatoid disease.

Purpose of the Study:

• To report an unusual case of neurological syndrome in a patient with severe rheumatoid arthritis.
• To investigate the pathological basis of the neurological symptoms through autopsy.
• To contribute to the limited literature on cerebral vasculitis in rheumatoid disease.

Main Methods:

• Case report of a 63-year-old male with rheumatoid arthritis.
• Clinical observation of neurological syndrome including dementia and blindness.
• Post-mortem autopsy to examine brain pathology.
• Histopathological analysis for vasculitis, infarcts, and amyloidosis.

Main Results:

• The patient presented with a Gerstmann syndrome-like neurological deficit, dementia, and blindness.
• Autopsy revealed extensive necrotizing vasculitis of the brain, resembling polyarteritis nodosa.
• Brain lesions, including numerous infarcts, were most severe in the posterior cerebral hemispheres.
• Severe amyloidosis of cerebral arterioles and senile plaques were observed in affected areas.

Conclusions:

• Necrotizing cerebral vasculitis can be a rare and devastating complication of severe rheumatoid arthritis.
• The pathological findings underscore the potential for systemic autoimmune disease to manifest with severe neurological sequelae.
• This case emphasizes the importance of considering vasculitis in the differential diagnosis of neurological decline in RA patients.