Richioud B, Béjot Y, Ornetti P, Ricolfi F, Sautreaux J-L, Ben Salem D
Service de neuroradiologie, CHU de Dijon, 3, rue Faubourg-Raines, 21033 Dijon cedex, France.
Rev Neurol (Paris). 2012 Apr;168(4):350-6. doi: 10.1016/j.neurol.2011.08.019. Epub 2012 Feb 28.
Rheumatoid nodules are possible extra-articular manifestations of rheumatoid arthritis. These lesions are mainly located in subcutaneous tissues but may also rarely affect deep organs, exceptionally the meninges.
We report herein a case of meningeal nodules observed in a 52-year-old man with rheumatoid arthritis who underwent brain MRI to explore an acute visual impairment. Subsequent MRIs showed similar new lesions contrasting with total regression of the initially observed lesions. The final control brain MRI performed four years after the onset of the ocular symptoms disclosed total involution of all the extra-axial nodular lesions, a course highly suggestive of meningeal rheumatoid nodules.
During the follow-up period of this case, the patient was treated with methotrexate at doses too low to cross the blood brain barrier. Consequently, it is most likely that the meningeal lesions developed during the natural course of the disease. Despite the non-specific features of the first imaging findings, the radiological changes observed over time were consistent with the final diagnosis of rheumatoid nodules.
