Saturday, May 17, 2014

RA meningitis as stroke mimic

Bourgeois P et al.  Rheumatoid arthritis presenting with stroke like episodes. Neurology 2014; 82: 1564-5. 
70 yo male presented with series of TIA like events over ten days consisting of right leg more than arm weakness.  He had poorly controlled RA.  MRI was negative for brain parenchyma but there was enhancement of meninges and pachymeningitis.  Meningeal biopsy was positive and patient was successfully treated by Solumedrol 1 gram per day followed by 1 mg/kg/day prednisone, tapered over months with no recurrence. 
Other reported presentations of RA meningitis include cranial neuropathy and seizures.  CSF is abnormal.  Authors propose that RF in CSF is a useful biomarker if positive as false negatives occur.  Path can show 3 patterns: rheumatoid nodules, meningeal inflammation or vasculitis.
In other series there was high mortality although this patient survived.

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