Cerebral vasculitis as a major manifestation of rheumatoid arthritis

Cerebral vasculitis (CV) is a rare described complication of rheumatoid arthritis (RA). Although the most frequent neurological manifestations of RA are peripheral neuropathy and cervical spinal cord compression due to subluxation of the cervical vertebrae, CV can be seen especially in patients with...

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Bibliographic Details
Published in:Acta clinica belgica (English ed. Online) 2015-10, Vol.70 (5), p.359-363
Main Authors: Ozkul, A., Yılmaz, A., Akyol, A., Kiylioglu, N.
Format: Article
Language:English
Subjects:
Adult
Anti-Inflammatory Agents - therapeutic use
Arthritis, Rheumatoid - complications
Cerebrovascular disease
Female
Humans
Magnetic Resonance Angiography
Male
Methylprednisolone - therapeutic use
Middle Aged
Rheumatoid arthritis
Transcranial doppler
Vasculitis
Vasculitis, Central Nervous System - complications
Vasculitis, Central Nervous System - diagnosis
Vasculitis, Central Nervous System - drug therapy
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Summary:Cerebral vasculitis (CV) is a rare described complication of rheumatoid arthritis (RA). Although the most frequent neurological manifestations of RA are peripheral neuropathy and cervical spinal cord compression due to subluxation of the cervical vertebrae, CV can be seen especially in patients with seropositive and long-standing RA. Clinical presentation: We report two cases of CV associated with RA. Both patients had no extraarticular manifestations and RA clinics were under control. Our first case is a 30-years-old woman with seropositive RA for 15 years who had suddenly onset left facial and upper extremity weakness. In magnetic resonance imaging (MRI) DWI, hyperintensity in frontotemporal region due to acute ischaemia was detected. The new lacuner acute ischaemic lesions in right precentral gyrus, bilateral frontoparietal and corpus callosal region were detected in the control MRI. The cerebral MR angiography and transcranial doppler findings were consistent with CV. The patient responded favourably to pulse methylprednisolone and oral azathiopurine treatments. The second patient is a 52-year-old man who had been RA for 29 years. He admitted to our neurology clinic with speech difficulty and right upper extremity minimal weakness. Magnetic resonance imaging DWI showed left parietooccipital acute ischaemia which was progressed within a week and a new right parietooccipital ischaemia was added. His cerebral MR angiography and cerebral angiography were concordant with CV. The cyclophosphamide therapy was started since the cerebral ischaemia was progressed during pulse methylprednisolone and he responded well to this therapy. Conclusion: CV due to RA is an uncommon serious complication which can be life-threatening. Therefore clinicians should be aware of the possibility of CV especially in progressive strokes in RA.
ISSN:1784-3286
2295-3337
DOI:10.1080/17843286.2015.1131965