Multiple Intracranial Nodules Associated With Rheumatoid Arthritis: Case Report

Mayu TAKAHASHI; Junkoh YAMAMOTO; Masaru IDEI; Yoshiteru NAKANO; Yoshiteru SOEJIMA; Takeshi SAITO; Daisuke AKIBA; Shigeru NISHIZAWA

doi:10.2176/nmc.cr2012-0259

Case Reports

Multiple Intracranial Nodules Associated With Rheumatoid Arthritis: Case Report

Mayu TAKAHASHI, Junkoh YAMAMOTO, Masaru IDEI, Yoshiteru NAKANO, Yoshiteru SOEJIMA, Takeshi SAITO, Daisuke AKIBA, Shigeru NISHIZAWA

Author information

Mayu TAKAHASHI
Department of Neurosurgery, University of Occupational and Environmental Health
Junkoh YAMAMOTO
Department of Neurosurgery, University of Occupational and Environmental Health
Masaru IDEI
Department of Neurosurgery, University of Occupational and Environmental Health
Yoshiteru NAKANO
Department of Neurosurgery, University of Occupational and Environmental Health
Yoshiteru SOEJIMA
Department of Neurosurgery, University of Occupational and Environmental Health
Takeshi SAITO
Department of Neurosurgery, University of Occupational and Environmental Health
Daisuke AKIBA
Department of Neurosurgery, University of Occupational and Environmental Health
Shigeru NISHIZAWA
Department of Neurosurgery, University of Occupational and Environmental Health

Keywords: intracranial granulation, choroid plexus, corticosteroid, long term follow-up, rheumatoid nodule

JOURNAL OPEN ACCESS

2014 Volume 54 Issue 4 Pages 317-320

DOI https://doi.org/10.2176/nmc.cr2012-0259

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Abstract

A 71-year-old woman with active rheumatoid arthritis (RA) was referred to our department because of multiple intracranial nodules. On admission, the RA disease activity was very high even after the treatment of methotrexate in other hospital. She underwent open biopsy to confirm a histopathological diagnosis of the intracranial lesions. Surgical specimen mainly consisted of necrosis surrounded by epithelioid cells. The masses were reduced spontaneously in size without additional treatment. Eleven month later, the lesions were relapsed. She underwent treatment with corticosteroid, and the lesions were remarkably regressed. The clinical course and histological examination were compatible with rheumatoid nodule (RN). Intracranial RN is extremely rare and its clinical course is not completely understood. In active RA patients, RNs should be considered, and histological diagnosis is inevitable for following suitable treatment.

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