Pachymeningitis and epilepsy in rheumatoid arthritis, MRI findings

Rheumatoid arthritis is a systemic disease in which cerebral involvement and epilepsy association are rare. Here, we describe a 37-year-old woman with a three-year history of rheumatoid arthritis presenting with headache and convulsive attack. The patient complained of severe headache and two generalized convulsions during the previous week. Laboratory data revealed positive RA test. MRI disclosed rheumatoid pachymeningitis. After oral diphenylhydatoin, methylprednisolone administration her headache subsided. In a two-year follow-up no additional convulsion attacks occurred. Hypertrophy of the dura disappeared. It is difficult to diagnose pachymeningitis when patients manifest only headache or convulsions. We suggest carrying out MRI in these cases.