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[A Surgical Case of Arachnoid Cyst With Rheumatoid Meningitis]
Yasushi Takeda1, Atsutomo Hashida1, Hirotsugu Ohta1
1Department of Neurosurgery, MOJI Medical Center.
Abstract:
Rheumatoid meningitis is a rare neurological manifestation that is difficult to diagnose. Here we report a 77-year-old woman who developed a left hemiparesis because of an arachnoid cyst with rheumatoid meningitis. The patient had a 13 year history of rheumatoid arthritis, which had been successfully treated. She developed left hemiparesis and visited our hospital. MRI showed a high signal intensity lesion in the right frontal subarachnoid space and an arachnoid cyst on Fluid attenuated inversion recovery (FLAIR). A gadolinium enhanced T1 weighted image revealed associated abnormal enhancement. We removed the arachnoid cyst and diagnosed the patient as having rheumatoid meningitis. Her symptoms and MRI findings improved rapidly by methylprednisolone pulse therapy. Rheumatoid meningitis is rare, but a case of arachnoid cyst associated with rheumatoid meningitis was extremely rare. This is the first report of such a case.
Insights
This report details an extremely rare case of rheumatoid meningitis presenting as an arachnoid cyst, causing hemiparesis in a rheumatoid arthritis patient. Prompt treatment with methylprednisolone pulse therapy led to rapid symptom and MRI improvement.
Area of Science:
- Neurology
- Rheumatology
- Neuroimaging
Background:
- Rheumatoid meningitis is a rare neurological complication of rheumatoid arthritis.
- Diagnosis can be challenging due to its infrequent and varied presentations.
Observation:
- A 77-year-old woman with a history of rheumatoid arthritis presented with left hemiparesis.
- MRI revealed an arachnoid cyst with abnormal enhancement in the right frontal subarachnoid space.
Findings:
- Surgical removal of the arachnoid cyst confirmed rheumatoid meningitis.
- Methylprednisolone pulse therapy resulted in rapid improvement of neurological symptoms and MRI findings.
Implications:
- This case highlights the importance of considering rheumatoid meningitis in patients with rheumatoid arthritis and neurological deficits.
- The association of rheumatoid meningitis with an arachnoid cyst is exceptionally rare, representing a unique clinical presentation.
- Early diagnosis and treatment are crucial for favorable outcomes in rheumatoid meningitis.
