PMC7249520_01
MRI scan of the brain on first admission to the hospital. The study description was prepared by prof. Edyta Szurowska. Axial TIRM dark fluid sequence - cerebral cortex oedema in the frontoparietal region of the right hemisphere with clamping grooves of brain and increase of their signal (A); axial DWI sequence - minor foci of diffusion reduction in the right parietal lobe (B); axial, contrast-enhanced T1 -dependent images- distinct enhancement of dura mater and pia mater in frontoparietal area (C).
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F1
MRI of the head (Fig. 1)showed hyper-intense signaling and diffusion restriction from the fronto-parieto-temporal region, additionally contrast studies showed leptomeningeal enhancement in the right hemisphere.
Histopathology of cerebro-meningeal biopsy. The study description was prepared by prof. Ewa Izycka-Swieszewska. Intense chronic inflammation with vasculitis and granulation tissue within leptomeninges and subarachnoid space as well as slight vasculitis of cortical vessels (HE, 100 x) (A); fibrosing granulation tissue with histiocytic multinucleated cell necrotizing granuloma and hyalinization of blood vessels walls (HE, 200 x) (B); inflammatory infiltrate made of foamy and multinucleated histiocytes, lymphocytes and plasmocytes (HE, 400 x) (C); chronic meningitis with active vasculitis in form of dense intraparietal and perivascular lympho-plasmocytic infiltrates, old extravasations with hemosiderin- laden macrophages and collagen fibers deposition (HE, 400 x) (D).
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F2
The neuropathological consultation of brain samples (Fig. 2), combined with the clinical presentation and laboratory results allowed to diagnose chronic rheumatoid meningitis and CNS vasculitis in the course of RA.
MRI scan of the brain after 6 months of immunosuppressive treatment. The study description was prepared by prof. Edyta Szurowska. Axial FLAIR sequence - regression of cerebral cortex oedema placed in the frontoparietal region of the right hemisphere, grooves of brain of proper width, visible only band-like area of gliosis in the area of surgical access (A); axial, contrast-enhanced T1 - dependent images - distinct regression of meninges enhancement in frontoparietal area, minor enhancement of post-biopsy site (B).
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F3
The control MRI (Fig. 3) revealed a decrease in temporal enhancement of the meninges.