Rheumatoid meningitis presented as recurrent stroke-like symptoms: A case report and literature review

IF 2.5 4区医学 Q3 IMMUNOLOGY

Journal of neuroimmunology Pub Date : 2025-09-24 DOI:10.1016/j.jneuroim.2025.578763

Xin Yang , Shuping Fang , Zilong Hao , Weihong Kuang

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引用次数: 0

Abstract

Introduction

Rheumatoid meningitis (RM) presents a diverse array of symptoms that can mimic stroke or transient ischemic attack (TIA), creating significant challenges for early clinical diagnosis.

Methods

This study reported on a patient who presented with recurrent stroke-like symptoms and was diagnosed with RM. Additionally, a literature review was conducted on PubMed using the terms “rheumatoid arthritis,” “central nervous system,” “meningitis,” and “rheumatoid meningitis” on December 20, 2023.

Results

Nineteen patients diagnosed with RM who exhibited stroke-like symptoms or TIA were included in the analysis. Of these, 58 % were male, with a median age of 65 years (range: 37–87 years). The duration of rheumatoid arthritis (RA) varied from 0 to 12 years. Approximately 80 % of patients showed meningeal enhancement on MRI, with 47 % displaying asymmetric enhancement, 21 % diffuse enhancement, and 5 % a mass-like lesion. CSF analysis revealed mild elevations in white blood cell count and protein in 68 % of patients. Biopsies were performed in 13 out of 19 cases, with 11 cases (85 %) showing chronic inflammation, including 10 with leptomeningitis or pachymeningitis, 1 with vasculitis, and 1 with necrotizing granulomatous meningitis. Corticosteroids were the most commonly used treatment.

Conclusion

For patients presenting with stroke-like or TIA symptoms who have a history of RA, it is crucial to consider RM in the differential diagnosis. Further research is needed to determine the most effective treatment strategies for these patients.

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类风湿性脑膜炎表现为复发性卒中样症状：1例报告及文献复习

类风湿性脑膜炎（RM）表现出多种症状，可模仿中风或短暂性脑缺血发作（TIA），为早期临床诊断带来重大挑战。方法本研究报告了一例反复出现卒中样症状并被诊断为RM的患者。此外，于2023年12月20日在PubMed上使用“类风湿关节炎”、“中枢神经系统”、“脑膜炎”和“类风湿脑膜炎”等术语进行了文献综述。结果本组共纳入了19例表现卒中样症状或TIA的RM患者。其中，58%为男性，中位年龄为65岁（范围：37-87岁）。类风湿关节炎（RA）的病程从0年到12年不等。大约80%的患者MRI表现为脑膜强化，47%为不对称强化，21%为弥漫性强化，5%为肿块样病变。脑脊液分析显示68%的患者白细胞计数和蛋白轻度升高。19例患者中有13例进行了活检，其中11例（85%）表现为慢性炎症，其中10例为轻脑膜炎或厚膜脑膜炎，1例为血管炎，1例为坏死性肉芽肿性脑膜炎。皮质类固醇是最常用的治疗方法。结论对于有RA病史的卒中样或TIA症状患者，鉴别诊断时应考虑RM。需要进一步的研究来确定对这些患者最有效的治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of neuroimmunology 医学-免疫学

CiteScore

6.10

自引率

3.00%

发文量

154

审稿时长

37 days

期刊介绍： The Journal of Neuroimmunology affords a forum for the publication of works applying immunologic methodology to the furtherance of the neurological sciences. Studies on all branches of the neurosciences, particularly fundamental and applied neurobiology, neurology, neuropathology, neurochemistry, neurovirology, neuroendocrinology, neuromuscular research, neuropharmacology and psychology, which involve either immunologic methodology (e.g. immunocytochemistry) or fundamental immunology (e.g. antibody and lymphocyte assays), are considered for publication.