Yagita Kaoru, Shinde Akiyo, Suenaga Toshihiko
Department of Neurology, Tenri Hospital, Tenri, Nara, Japan.
BMJ Case Rep. 2019 Aug 22;12(8):e229642. doi: 10.1136/bcr-2019-229642.
A 65-year-old woman with long-standing rheumatoid arthritis (RA) experienced a recurrent tingling sensation in her left arm followed by aphasia and a tingling sensation in her right arm. A subsequent imaging study showed bilateral subdural fluid accumulation and we initially diagnosed her with a transient ischaemic attack and chronic subdural haematoma (CSDH). The cerebral spinal fluid study revealed an inflammatory response without any indications of infection or malignant tumours. After a meningeal biopsy, we redefined the diagnosis to rheumatoid meningitis (RM), and the patient showed remarkable improvement with prednisolone administration. RM should be considered as an alternative diagnosis when examining central nervous system diseases in patients with RA, as RM presents a highly variable clinical picture with image findings similar to those of CSDH.
一名患有长期类风湿性关节炎（RA）的65岁女性，左臂反复出现刺痛感，随后出现失语，右臂也有刺痛感。随后的影像学检查显示双侧硬膜下积液，我们最初诊断她为短暂性脑缺血发作和慢性硬膜下血肿（CSDH）。脑脊液检查显示有炎症反应，但没有任何感染或恶性肿瘤的迹象。经过脑膜活检，我们将诊断重新定义为类风湿性脑膜炎（RM），患者在使用泼尼松龙后有显著改善。在检查RA患者的中枢神经系统疾病时，应考虑RM作为一种替代诊断，因为RM呈现出高度可变的临床症状，其影像学表现与CSDH相似。
