Rheumatoid meningitis can present MRI findings that mimic chronic subdural haematoma

Area of Science:

• Neurology
• Rheumatology
• Immunology

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily affecting joints.
• Central nervous system (CNS) involvement in RA is rare but can present with diverse symptoms.
• Distinguishing RA-related CNS complications from other neurological disorders is challenging.

Observation:

• A 65-year-old female with a history of RA presented with recurrent neurological symptoms including arm paresthesia and aphasia.
• Initial investigations revealed bilateral subdural fluid collections, leading to a suspected diagnosis of transient ischemic attack and chronic subdural hematoma.
• Cerebrospinal fluid analysis indicated an inflammatory process without signs of infection or malignancy.

Findings:

• A meningeal biopsy confirmed the diagnosis of rheumatoid meningitis (RM).
• The patient experienced significant clinical improvement following treatment with prednisolone.
• RM can present with imaging findings similar to chronic subdural hematoma, complicating diagnosis.

Implications:

• Rheumatoid meningitis should be considered in the differential diagnosis of CNS diseases in RA patients.
• The variable clinical presentation of RM necessitates a high index of suspicion.
• Prompt diagnosis and immunosuppressive therapy can lead to favorable outcomes in RM.