Rheumatoid disease of the CNS with meningeal vasculitis presenting with a seizure

Abstract

We describe a patient with rheumatoid arthritis (RA) and involvement of the meninges. A 54-year-old woman presented with 1 week of severe, persistent headaches and an episode of left arm jerking followed by loss of consciousness and persistent left hemiparesis. She had seropositive RA for 6 years. She initially was treated with corticosteroids but developed two vertebral compression fractures and for the last 3 years she was treated with methotrexate (MTX). She had severe deformities of the hands but no subcutaneous nodules and except for slight left hemiparesis, her physical examination was normal. Laboratory results included an erythrocyte sedimentation rate of 92 and rheumatoid factor (RF) of 670. The CSF was characterized by three neutrophils per mm3 and a protein value of 32 mg/dL. A gadolinium-enhanced MRI of the brain demonstrated extraaxial enhancement …