Intracranial rheumatoid nodule causing recurrent transient neurological deficits

Area of Science:

• Neurology
• Rheumatology
• Pathology

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily affecting joints.
• Neurological complications in RA can occur, but intracranial manifestations are less common.

Observation:

• A 67-year-old male patient with RA presented with recurrent focal neurological deficits.
• Cerebral imaging revealed a left parieto-occipital mass lesion.
• Standard stroke workup was inconclusive, prompting further investigation.

Findings:

• Brain biopsy confirmed the lesion was a rheumatoid nodule, not a typical tumor.
• The nodule induced a significant inflammatory response, mimicking a cerebral mass.
• Treatment with corticosteroids and rituximab led to clinical improvement.

Implications:

• Rheumatoid nodules, though rare, can manifest as intracranial mass lesions.
• This case highlights the importance of considering rheumatoid nodules in the differential diagnosis of cerebral masses in RA patients.
• Early recognition and appropriate treatment can improve patient outcomes.