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Reversible Parkinsonism With Recovery of 123 I-Ioflupane DAT‑SPECT After Treating Rheumatoid Meningitis

Taro Bannai1, Koshiro Yoshii, Minako Yamada

  • 1Department of Neurology, Tokyo Teishin Hospital, Tokyo, Japan.

Clinical Nuclear Medicine
|February 13, 2026
PubMed

Insights

Rheumatoid meningitis can cause reversible parkinsonism and brain changes. Immunotherapy effectively treated these symptoms, normalizing brain imaging and restoring function.

Area of Science:

  • Neurology
  • Immunology
  • Radiology

Background:

  • Rheumatoid meningitis is a rare complication of rheumatoid arthritis.
  • Parkinsonism can be a presenting symptom of central nervous system involvement in autoimmune diseases.

Purpose of the Study:

  • To report a case of reversible parkinsonism secondary to rheumatoid meningitis.
  • To investigate the utility of 123I-ioflupane DAT-SPECT in assessing dopaminergic dysfunction in this condition.

Main Methods:

  • Case report of a 42-year-old male with fever, encephalopathy, seizures, and parkinsonism.
  • Neuroimaging including MRI and 123I-ioflupane DAT-SPECT.
  • Cerebrospinal fluid (CSF) analysis.
  • Treatment with high-dose intravenous methylprednisolone and subsequent taper.

Main Results:

  • MRI revealed pachy/leptomeningeal enhancement and sulcal FLAIR hyperintensity.
  • CSF showed lymphocytic pleocytosis and elevated protein with negative infectious studies.
  • Baseline 123I-ioflupane DAT-SPECT demonstrated reduced striatal uptake.
  • Symptoms resolved rapidly following immunotherapy, with normalization of DAT-SPECT findings on follow-up.
  • Reductions in intrathecal anti-CCP index and CSF IL-6 correlated with clinical improvement.

Conclusions:

  • Reversible parkinsonism can occur in the context of rheumatoid meningitis.
  • Immunotherapy is an effective treatment, leading to clinical and radiological improvement.
  • 123I-ioflupane DAT-SPECT can track reversible presynaptic dopaminergic dysfunction in autoimmune meningitis.
Keywords:
autoimmune parkinsonismdopamine transporter SPECT (DAT-SPECT)gadolinium-enhanced FLAIRrheumatoid meningitis

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