Rheumatoid pachymeningitis

Starosta MA et al. Clinical manifestations and treatment of r.p. Neurology 2007;68:1079-1080.

Disorder can occur early or after many years of RA, RF and ESR are usually elevated but the esr may be only middling. The usual presentation is headache or cn palsy esp cn 8. On biopsy, unlike autopsy, nodules are infrequently found, in dura, and path showsx inflammatory cells, fibrosis. In autopsy series, the finding is nodules with central necrosis with histiocytes and mononuclear esp. plasma cells. Treatment with prednisone and other drugs (MTX, cytoxan) are effective.