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Rheumatoid meningitis presented as recurrent stroke-like symptoms: A case report and literature review

Xin Yang1, Shuping Fang1, Zilong Hao2

  • 1Mental Health Center of West China Hospital, Sichuan University, Chengdu, China.

Journal of Neuroimmunology
|September 28, 2025
PubMed
Abstract

Insights

Rheumatoid meningitis (RM) can mimic stroke symptoms, posing diagnostic challenges. Early consideration of RM in rheumatoid arthritis (RA) patients with stroke-like symptoms is crucial for timely diagnosis and management.

Area of Science:

  • Neurology
  • Rheumatology
  • Infectious Diseases

Background:

  • Rheumatoid meningitis (RM) presents with diverse symptoms, often mimicking stroke or transient ischemic attack (TIA).
  • This diagnostic challenge necessitates increased awareness among clinicians, particularly for patients with a history of rheumatoid arthritis (RA).

Purpose of the Study:

  • To investigate the clinical characteristics, diagnostic findings, and treatment of rheumatoid meningitis (RM) in patients presenting with stroke-like symptoms.
  • To highlight the importance of considering RM in the differential diagnosis of stroke in RA patients.

Main Methods:

  • A case report of a patient with recurrent stroke-like symptoms diagnosed with RM.
  • A comprehensive literature review of PubMed using keywords: "rheumatoid arthritis," "central nervous system," "meningitis," and "rheumatoid meningitis."
  • Analysis of clinical data, neuroimaging (MRI), cerebrospinal fluid (CSF) analysis, and histopathological findings from 19 RM patients with stroke-like symptoms.

Main Results:

  • 19 patients with RM and stroke-like symptoms were analyzed; 58% were male, median age 65 years.
  • MRI revealed meningeal enhancement in 80% of patients. CSF analysis showed mild abnormalities in 68%.
  • Biopsies confirmed chronic inflammation in 85% of cases, including leptomeningitis/pachymeningitis. Corticosteroids were the primary treatment.

Conclusions:

  • Rheumatoid meningitis (RM) should be strongly considered in the differential diagnosis for patients with rheumatoid arthritis (RA) presenting with stroke-like symptoms or TIA.
  • Further research is required to establish optimal treatment strategies for RM to improve patient outcomes.
Keywords:
Anti-CCPCase reportRheumatoid arthritisRheumatoid meningitisStroke-like

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