Neurology: Case of the Month

Test Yourself — Patient 29

Rheumatoid Arthritis with Associated CNS Vasculitis

  1. The differential diagnosis for a rapidly progressive dementia includes all of the following, EXCEPT:
    • [ A ] Spongiform encephalopathy
    • [ B ] Glioblastoma multiforme
    • [ C ] CNS vasculitis
    • [ D ] Parkinson's disease
    • [ E ] Cryptococcal meningitis
  2. Which of the following is the most helpful test in confirming the diagnosis of CNS vasculitis?
    • [ A ] Brain biopsy
    • [ B ] Four vessel cerebral angiogram
    • [ C ] Magnetic resonance angiogram
    • [ D ] Erythrocyte sedimentation rate
    • [ E ] Rheumatoid factor
  3. Which of the following statements regarding rheumatoid vasculitis is TRUE?
    • [ A ] Vasculitis is a common cause of stroke in the elderly and the diagnosis should be aggressively pursued in all elderly stroke patients.
    • [ B ] The pathologic diagnosis of vasculitis is confirmed by the presence of inflammatory cells surrounding cerebral blood vessels.
    • [ C ] The most common neurological manifestation of CNS vasculitis associated with rheumatoid arthritis is alteration in mental status.
    • [ D ] The primary treatment is with anticoagulation to prevent the frequent occurrence of cerebral emboli.
    • [ E ] The typical joint deformities and other manifestations of rheumatoid arthritis are rarely found in patients who manifest evidence of CNS vasculitis as well.
  4. Which of the following may present with the triad of dementia, urinary incontinence, and gait disorder?
    • [ A ] Small vessel ischemia and infarction involving the frontal lobes
    • [ B ] Frontal lobe meningioma
    • [ C ] CNS vasculitis
    • [ D ] All of the above
  5. Viable treatment options for vasculitis associated with rheumatoid arthritis include which of the following?
    • [ A ] Immunosuppression with Cytoxan
    • [ B ] Baclofen
    • [ C ] Midodrine
    • [ D ] Cylert
    • [ E ] D-turbocurarine

 

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