Department of Neurology, Kumamoto Rosai Hospital, Japan.
Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan.
Intern Med. 2021 Mar 15;60(6):935-940. doi: 10.2169/internalmedicine.5974-20. Epub 2020 Oct 21.
Cerebral rheumatoid vasculitis (CRV) is a rare, fatal, and diagnostically challenging disorder. We herein report an 81-year-old woman with a 4-year history of rheumatoid arthritis who presented with a fever, progressive disturbance of consciousness, high level of rheumatoid factor, and hypocomplementemia. The enhancement of the perforating branches in the left middle cerebral artery led us to suspect CRV. A brain biopsy could not be performed. After we intensified steroid therapy, the size of the cerebral lesions temporarily decreased. However, recurrence in the left frontal lobe occurred one month later, and the patient subsequently died. Early intensive treatments may be needed for CRV.
脑类风湿性血管炎（CRV）是一种罕见的、致命的、诊断具有挑战性的疾病。我们在此报告一例 81 岁女性，患有类风湿关节炎 4 年，表现为发热、进行性意识障碍、类风湿因子水平升高和补体水平降低。左侧大脑中动脉穿支的强化提示我们怀疑为 CRV。未能进行脑活检。强化类固醇治疗后，脑病变大小暂时缩小。然而，一个月后左侧额叶再次复发，患者随后死亡。CRV 可能需要早期强化治疗。
