LEPTOMENINGEAL INFLAMMATION IN RHEUMATOID ARTHRITIS

A 44-year-old man with a 20-year history of seroposi-tive erosive rheumatoid arthritis (RA), diagnosed according to the American Rheumatology Association revised criteria,1 was referred for severe headache and partial simple motor seizures. At the time of presenta-tion, his disease was inactive under a stable dose of methylprednisolone (8 mg/day). The neurologic exam-ination was normal: there were no cranial nerve palsies, sensory motor deficits, gait imbalance, impairment of cognitive functions, or neck stiffness. Fundoscopy did not reveal any abnormality. The major finding on neu-roimaging was a marked leptomeningeal enhancement (figure, A, C, and E). CSF analysis showed a normal opening pressure, normal cell count, and a slightly increased immunoglobulin G index; viral markers an