Brossard-Barbosa Natalie, Donaldson Laura, Sokolova Elena, AlShafai Laila, Margolin Edward
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada.
Pract Neurol. 2023 Feb;23(1):78-81. doi: 10.1136/pn-2022-003489. Epub 2022 Oct 5.
A 67-year-old man with rheumatoid arthritis developed recurrent acute onset of stereotyped focal neurological abnormalities. Cerebral imaging showed a mass lesion in the left parieto-occipital lobe. Imaging did not show the time evolution expected in stroke and so he underwent an extensive workup, which was inconclusive. Brain biopsy identified a rheumatoid nodule causing an extensive inflammatory reaction that mimicked a mass. Following treatment with intravenous corticosteroids and rituximab infusions, his clinical condition improved. While rheumatoid meningitis is well recognised, a rheumatoid nodule in the brain rarely presents as a mass lesion. Nevertheless, it is important to consider rheumatoid nodule in the differential diagnosis of a cerebral mass lesion in patients with rheumatoid arthritis.
一名67岁的类风湿性关节炎男性患者反复出现刻板性局灶性神经功能异常的急性发作。脑部影像学检查显示左顶枕叶有一个肿块病变。影像学检查未显示出中风预期的时间演变，因此他接受了全面检查，但结果尚无定论。脑活检发现一个类风湿结节，引发了类似肿块的广泛炎症反应。经静脉注射皮质类固醇和利妥昔单抗治疗后，他的临床状况有所改善。虽然类风湿性脑膜炎已广为人知，但脑部的类风湿结节很少表现为肿块病变。然而，在类风湿性关节炎患者脑肿块病变的鉴别诊断中考虑类风湿结节是很重要的。
