Yamaoka Minako, Izumi Tesseki, Eura Nobuyuki, Sasaki Ryota, Kiriyama Takao, Sugie Kazuma
Department of Neurology, Nara Medical University.
Department of Neurosurgery, Nara Medical Center.
Rinsho Shinkeigaku. 2020 Sep 29;60(9):631-635. doi: 10.5692/clinicalneurol.cn-001458. Epub 2020 Aug 8.
We report a 62-year-old female with rheumatoid meningitis. She presented with mental disorder, loss of consciousness, generalized seizures, and cognitive impairment. Brain MRI demonstrated high intensity lesions and abnormal enhancement along the left frontal and parietal sulci. Her serum and cerebrospinal fluid were positive for anti-cyclic citrullinated peptides (CCP) antibody, and the antibody index of cerebrospinal fluid anti-CCP antibody increased, which led us to suspect rheumatoid meningitis. Her symptoms improved immediately by methylpredonisolone pulse therapy and anti-CCP antibody turned negative in cerebrospinal fluid. However, she revealed arthritis with the reduction of betamethasone and was diagnosed as rheumatoid arthritis. We suggest that the elevation of antibody index of cerebrospinal fluid anti-CCP antibody is useful in the diagnosis of rheumatoid meningitis preceding neurological symptoms without arthritis, and anti-CCP antibody in cerebrospinal fluid may be helpful as the evaluation of the treatment.
我们报告了一名62岁的类风湿性脑膜炎女性患者。她出现了精神障碍、意识丧失、全身性癫痫发作和认知障碍。脑部磁共振成像（MRI）显示左侧额叶和顶叶脑沟处有高强度病变及异常强化。她的血清和脑脊液抗环瓜氨酸肽（CCP）抗体呈阳性，脑脊液抗CCP抗体的抗体指数升高，这使我们怀疑为类风湿性脑膜炎。经甲泼尼龙冲击治疗后，她的症状立即改善，脑脊液中的抗CCP抗体转为阴性。然而，随着倍他米松减量，她出现了关节炎，并被诊断为类风湿关节炎。我们认为，脑脊液抗CCP抗体抗体指数升高有助于在无关节炎的神经系统症状之前诊断类风湿性脑膜炎，脑脊液中的抗CCP抗体可能有助于评估治疗效果。
