Login Register Cart 0
Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Case Report

Unusual Cerebral Involvement of Rheumatoid Arthritis Mimicking a Tumor

Author(s): Sevil Tokdemir*, Huseyin Toprak and Alpay Alkan

Volume 16, Issue 2, 2020

Page: [145 - 148] Pages: 4

DOI: 10.2174/1573405614666180911121222

Price: $65

Abstract

Background: The central nervous system’s involvement in Rheumatoid Arthritis (RA) is infrequent and can be life-threatening. Mass-like CNS involvement is an unusual presentation. A 45 year old man had suffered seropositive rheumatoid arthritis for five years referred to our hospital with one-week history of right-sided facial paralysis, left hemiparesis and headache.

Discussion: MRI demonstrated hyperintense mass-like lesion extended from mesencephalon to right hippocampus and basal ganglia on T2 and FLAIR images. On DWI, restricted diffusion was not present. After contrast administration, minimal contrast enhancement was noted. After methotrexate and steroid treatment, the size had been markedly shrunken on the follow-up images. The clinical symptoms were also improved.

Conclusion: To our knowledge, the mass-like presentation was not reported in the literature. We report an unusual case of brain involvement of rheumatoid arthritis mimicked tumor.

Keywords: Rheumatoid arthritis, inflammatory pseudotumor, magnetic resonance imaging, cerebral, brain, CNS.

Graphical Abstract

[1]
Kurne A, Karabudak R, Karadag O, et al. An unusual central nervous system involvement in rheumatoid arthritis: combination of pachymeningitis and cerebral vasculitis. Rheumatol Int 2009; 29(11): 1349-53.
[http://dx.doi.org/10.1007/s00296-008-0810-6] [PMID: 19093117]
[2]
Sommer OJ, Kladosek A, Weiler V, Czembirek H, Boeck M, Stiskal M. Rheumatoid arthritis: a practical guide to state-of-the-art imaging, image interpretation, and clinical implications. Radiographics 2005; 25(2): 381-98.
[http://dx.doi.org/10.1148/rg.252045111] [PMID: 15798057]
[3]
Akrout R, Bendjemaa S, Fourati H, et al. Cerebral rheumatoid vasculitis: a case report. J Med Case Reports 2012; 6: 302.
[http://dx.doi.org/10.1186/1752-1947-6-302] [PMID: 22974191]
[4]
Emmer BJ, van der Bijl AE, Huizinga TWJ, et al. Brain involvement in rheumatoid arthritis: a magnetic resonance spectroscopy study. Arthritis Rheum 2009; 60(11): 3190-5.
[http://dx.doi.org/10.1002/art.24932] [PMID: 19877035]
[5]
Waisman A, Hauptmann J, Regen T. The role of IL-17 in CNS diseases. Acta Neuropathol 2015; 129(5): 625-37.
[http://dx.doi.org/10.1007/s00401-015-1402-7] [PMID: 25716179]
[6]
D’Mello C, Le T, Swain MG. Cerebral microglia recruit monocytes into the brain in response to tumor necrosis factoralpha signaling during peripheral organ inflammation. J Neurosci 2009; 29(7): 2089-102.
[http://dx.doi.org/10.1523/JNEUROSCI.3567-08.2009] [PMID: 19228962]
[7]
Banks WA, Robinson SM. Minimal penetration of lipopolysaccharide across the murine blood-brain barrier. Brain Behav Immun 2010; 24(1): 102-9.
[http://dx.doi.org/10.1016/j.bbi.2009.09.001] [PMID: 19735725]
[8]
Pan W, Kastin AJ. TNFalpha transport across the blood-brain barrier is abolished in receptor knockout mice. Exp Neurol 2002; 174(2): 193-200.
[http://dx.doi.org/10.1006/exnr.2002.7871] [PMID: 11922661]
[9]
Nishioku T, Furusho K, Tomita A, et al. Potential role for S100A4 in the disruption of the blood-brain barrier in collagen-induced arthritic mice, an animal model of rheumatoid arthritis. Neuroscience 2011; 189: 286-92.
[http://dx.doi.org/10.1016/j.neuroscience.2011.05.044] [PMID: 21627981]
[10]
Nishioku T, Dohgu S, Takata F, et al. Detachment of brain pericytes from the basal lamina is involved in disruption of the blood-brain barrier caused by lipopolysaccharide-induced sepsis in mice. Cell Mol Neurobiol 2009; 29(3): 309-16.
[http://dx.doi.org/10.1007/s10571-008-9322-x] [PMID: 18987969]
[11]
Nishioku T, Yamauchi A, Takata F, et al. Disruption of the blood-brain barrier in collagen-induced arthritic mice. Neurosci Lett 2010; 482(3): 208-11.
[http://dx.doi.org/10.1016/j.neulet.2010.07.035] [PMID: 20654699]
[12]
Bao L, Zhu Y, Elhassan AM, et al. Adjuvant-induced arthritis: IL-1 beta, IL-6 and TNF-alpha are up-regulated in the spinal cord. Neuroreport 2001; 12(18): 3905-8.
[http://dx.doi.org/10.1097/00001756-200112210-00010] [PMID: 11742208]
[13]
Hamed SA, Selim ZI, Elattar AM, Elserogy YM, Ahmed EA, Mohamed HO. Assessment of biocorrelates for brain involvement in female patients with rheumatoid arthritis. Clin Rheumatol 2012; 31(1): 123-32.
[http://dx.doi.org/10.1007/s10067-011-1795-1] [PMID: 21695659]
[14]
Gonçalves CA, Leite MC, Nardin P. Biological and methodological features of the measurement of S100B, a putative marker of brain injury. Clin Biochem 2008; 41(10-11): 755-63.
[http://dx.doi.org/10.1016/j.clinbiochem.2008.04.003] [PMID: 18454941]
[15]
Teeling JL, Carare RO, Glennie MJ, Perry VH. Intracerebral immune complex formation induces inflammation in the brain that depends on Fc receptor interaction. Acta Neuropathol 2012; 124(4): 479-90.
[http://dx.doi.org/10.1007/s00401-012-0995-3] [PMID: 22618994]
[16]
Fuggle NR, Howe FA, Allen RL, Sofat N. New insights into the impact of neuro-inflammation in rheumatoid arthritis. Front Neurosci 2014; 8: 357.
[http://dx.doi.org/10.3389/fnins.2014.00357] [PMID: 25414636]
[17]
Acton QA. Rheumatoid arthritis. New insights for the healthcare Professional. 2013.
[18]
Parvez K, Arfaj AA, Naseeb F. Daif Ak, Hussain S, Hamdani A. Pattern of MRI brain abnormalities in rheumatic patients with neurological involvement: a tertiary care teaching hospital experience. PAFMJ 2015; 65(4): 530-4.
[19]
Bekkelund SI, Pierre-Jerome C, Husby G, Mellgren SI. Quantitative cerebral MR in rheumatoid arthritis. AJNR Am J Neuroradiol 1995; 16: 767-2.
[20]
Bilge NŞ, Şaylısoy S, Kaşifoglu T, Korkmaz C. Mass-like lesions as a rare form of neuro-Behçet’s disease: a case report and review of the literature. Eur J Rheumatol 2014; 1(1): 34-8.
[http://dx.doi.org/10.5152/eurjrheum.2014.007] [PMID: 27708868]
[21]
Matsuo K, Yamada K, Nakajima K, Nakagawa M. Neuro-Behçet disease mimicking brain tumor. AJNR Am J Neuroradiol 2005; 26(3): 650-3.
[PMID: 15760881]

Rights & Permissions Print Cite
Article Metrics
11
1
© 2024 Bentham Science Publishers | Privacy Policy