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Washington University Experience | MISCELLANEOUS | Rheumatoid Nodule - Pachymeningitis - Odontoid subluxation | 4A0 Case 4 History
Case 4 History (AANP Diagnostic Slide session 2001, Case 6) ---- The patient was a 78 year old woman with a two month history of ataxia and mild memory loss with transient right leg paresthesias and intermittent weakness. She was admitted following an episode of speech arrest with right leg weakness. The patient's past relevant medical history included rheumatoid arthritis and osteoporosis with a history of a lumbar compression fracture. A sister had presented with a very similar set of symptoms. Neurologic evaluation of the patient at the time of admission found that she was oriented to person and place but not time and her mentation appeared slowed. Cranial imaging revealed hydrocephalus, dural and leptomeningeal enhancement, and several superficial cortical lesions. One of her enhancing intracranial lesions was biopsied, a diagnosis of rheumatoid meningitis made. She subsequently was treated with methotrexate, cyclophosphamide, and gold. The patient had severe rheumatoid arthritis with rheumatoid skin lesions.
