Central nervous system vasculitis is a rarely described complication o
f rheumatoid arthritis. We report a case of cerebral vasculitis in a 5
5-year-old woman with a 7-year history of seropositive, nodular rheuma
toid arthritis. Striking multifocal abnormalities of the white matter
on magnetic resonance imaging led to a suspicion of vasculitis despite
lack of clinical evidence of extracranial vasculitis and normal findi
ngs on cerebrospinal fluid studies and cerebral angiography. After ins
titution of treatment with glucocorticoids and azathioprine, she survi
ved in stable condition for 14 months from the onset of symptoms. Post
mortem examination of the brain revealed vasculitis and chronic ischem
ic changes.