A case of rheumatoid meningitis: findings on diffusion-weighted image versus FLAIR image

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  • Matsuura Daisuke
    Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences
  • Ohshita Tomohiko
    Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences
  • Nagano Yoshito
    Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences
  • Ohtsuki Toshiho
    Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences
  • Kohriyama Tatsuo
    Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences
  • Matsumoto Masayasu
    Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences

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Other Title
  • ＭＲＩ拡散強調画像にてくも膜下腔に高信号域をみとめたリウマチ性髄膜炎の１例―ＦＬＡＩＲ画像との比較―
  • 症例報告 MRI拡散強調画像にてくも膜下腔に高信号域をみとめたリウマチ性髄膜炎の1例--FLAIR画像との比較
  • ショウレイ ホウコク MRI カクサン キョウチョウ ガゾウ ニテ クモマクカコウ ニ コウシンゴウイキ オ ミトメタ リウマチセイ ズイマクエン ノ 1レイ FLAIR ガゾウ トノ ヒカク

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Abstract

We report a 63-year-old man with rheumatoid meningitis. At 47-years-old, he developed rheumatoid vasculitis causing arthralgia and skin ulcer. Although the patient had been treated with prednisolone and cyclosporine A, headache and recurrent focal seizures of the right upper limb and generalized seizures developed. Brain magnetic resonance imaging showed high signal intensity lesions on FLAIR MRI and associated abnormal enhancement of the leptomeninges. Part of the lesions also showed patchy high signal intensity on diffusion-weighted imaging (DWI). This features may be useful for differentiating rheumatoid meningitis from subdural empyema, because the extent of the lesions on DWI matches the lesion on FLAIR imaging in patients with subdural empyema. Cerebrospinal fluid analysis revealed monocytic pleocytosis and negative findings for infection or malignancy. After intravenous administration of methylprednisolone (1,000mg/day for 3 days), the patient showed improvements in headache, cerebrospinal fluid findings and abnormal hyperintensity on DWI.<br> Rheumatoid meningitis is an extremely rare neurological manifestation, but careful attention should be paid even in the inactive stage of rheumatoid arthritis. This disease tends to present with unilateral supratentorial lesions. In this case, serial diffusion-weighted and FLAIR MRI was useful for following the leptomeningeal lesions.<br>

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 48 (3), 191-195, 2008

    Societas Neurologica Japonica

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