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Neurological rarities
Intracranial rheumatoid nodule causing recurrent transient neurological deficits
  1. Natalie Brossard-Barbosa1,
  2. Laura Donaldson1,
  3. Elena Sokolova2,
  4. Laila AlShafai3,
  5. Edward Margolin1
  1. 1 Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
  2. 2 Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada
  3. 3 Medical Imaging, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  1. Correspondence to Dr Edward Margolin, Department of Ophthalmology and Vision Science, University of Toronto, Toronto, ON M5S 1A1, Canada; Edward.margolin{at}uhn.ca

Abstract

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.

  • neuropathology
  • neuroophthalmology
  • rheumatology

Data availability statement

No data are available.

https://doi.org/10.1136/pn-2022-003489

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    Data availability statement

    No data are available.

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    Footnotes

    • Correction notice This article has been corrected since it was published Online First. Erroneously removed words have been re-added in the abstract.

    • Contributors All authors contributed equally to data acquisition, manuscript writing, editing and final approval.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed by Marija Cauchi, Msida, Malta, and Neil Scolding, Bristol, UK.