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Leptomeningeal rheumatoid nodules: diagnosis and failed therapeutics

Cassie Nesbitt1, Luke Willshire1, Doreen Quan2

  • 1Department of Neurology, Barwon Health/Geelong Hospital, Ryrie Street, Geelong, P.O. Box 281, VIC 3220, Australia.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|December 24, 2014
PubMed

Insights

Rheumatoid nodules in the meninges are rare, presenting as transient ischemic attack-like episodes. This case highlights the diagnostic challenges and unpredictable clinical course of meningeal rheumatoid nodules.

Area of Science:

  • Neurology
  • Rheumatology
  • Pathology

Background:

  • Recurrent transient ischemic attack-like episodes over two years in a 67-year-old woman.
  • Magnetic Resonance Imaging (MRI) revealed nodular enhancing leptomeningeal changes.

Observation:

  • Biopsy confirmed the presence of meningeal rheumatoid nodules.
  • The patient's nodular disease exhibited unpredictable progression and regression.

Findings:

  • Clinical and radiological changes fluctuated irrespective of disease-modifying agents.
  • Peripheral and serological rheumatoid arthritis control did not influence meningeal nodule activity.

Implications:

  • This case underscores the diagnostic complexity of meningeal rheumatoid nodules.
  • The unpredictable nature of the disease presents therapeutic management dilemmas.
Keywords:
BiopsyBrainImmunomodulatorsLeptomeningealRheumatoid nodules

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