- Neurosurgical urgency arises from inflammatory vascular compromise, cervical instability or occult fracture causing neurologic deficits, and mass-like or meningeal presentations mimicking malignancy.
- Pattern-based triage and targeted high-yield imaging are essential to distinguish inflammatory, infectious, and neoplastic mimics and to prioritise neurosurgical evaluation.
- Neurosurgical interventions are limited: stabilisation, CSF diversion, decompression, or biopsy when medical therapy is insufficient or diagnosis is uncertain.
Rheum Dis Clin North Am. 2026 Nov;52(4):727-738. doi: 10.1016/j.rdc.2026.08.006. Epub 2026 Sep 4.
ABSTRACT
This article reviews the neurosurgical considerations and clinical manifestations of giant cell arteritis, rheumatoid arthritis-related cervical spine disease, ankylosing spondylitis, systemic lupus erythematosus, neurosarcoidosis, and Lyme disease. Across these disease entities, neurosurgical urgency typically reflects inflammatory vascular compromise, skeletal instability, occult fracture with secondary neurologic deficits, or mass-like and meningeal phenotypes that mimic malignancy or infection. The article emphasizes pattern-based triage, high-yield imaging selection, and the limited scenarios requiring neurosurgical intervention including stabilization, CSF diversion, decompression, or biopsy.
PMID:42849992 | DOI:10.1016/j.rdc.2026.08.006
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