Leptomeningeal Rheumatoid Nodules: Diagnosis and Challenging Therapeutics

Introduction: Leptomeningeal rheumatoid nodules are a rare condition. This case demonstrates the unique presentation and diagnostic workup for the distinctive condition and highlights the difficulties surrounding therapeutics. Case Presentation: A 67 year old woman presented with recurrent transient ischaemic attack-like episodes over a 2 year period. Nodular enhancing leptomeningeal changes were detected on MRI and consistent with meningeal rheumatoid nodules on biopsy. The patient’s nodular disease continued to progress and regress clinically and radiologically irrespective of disease modifying agents and peripheral and serological rheumatoid arthritis control. Conclusions: This patient’s unique presentation and diagnostic work-up is discussed alongside the dilemma of therapeutic management of meningeal rheumatoid nodules.