Cauda equina syndrome resulting from lumbar arachnoiditis after intracranial subarachnoid hemorrhage: a case report.

Spinal arachnoiditis is a known but very rare late complication of subarachnoid hemorrhage (SAH). Since 1943, 17 cases of spinal arachnoiditis after intracranial hemorrhage have been reported internationally. The vast majority of these cases were related to aneurysmal SAH. All previously published cases have involved spinal arachnoiditis at the cervical and thoracic levels. In this report, we present an adult woman with lumbar spinal arachnoiditis causing cauda equina syndrome as a result of posterior circulation aneurysmal SAH. We believe this is the first reported case of this specific condition causing cauda equina syndrome.

Arachnoiditis.

Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The topic addressed in this issue is arachnoiditis, its symptoms, and possible treatment approaches.

Terminal ventriculostomy as an adjuvant treatment of complex syringomyelia: a case report and review of the literature.

Complex syringomyelia is multifactorial, and treatment strategies are highly individualized. In refractory cases, sectioning of the filum terminale, also known as terminal ventriculostomy, has been described as a potential adjuvant treatment to alleviate syrinx progression. A 10-year-old boy with a history of arachnoiditis presented with complex syringomyelia, progressive lower extremity motor weakness, and spasticity. Previously, he had failed spinal cord detethering and direct syrinx shunting. Imaging studies demonstrated a holocord syrinx extending to the level of his conus medullaris and into the filum terminale. The patient underwent an uncomplicated lumbar laminectomy and transection of the filum terminale. Operative pathologic specimens demonstrated a dilated central canal within the filum. Postoperative imaging demonstrated significant reduction in the diameter of the syrinx. At follow-up, the patient's motor symptoms had improved. Terminal ventriculostomy may be a useful adjuvant in treating caudally placed syringes refractory to other treatments. This procedure carries low neurological risk and involves no hardware implantation. In select cases, terminal ventriculostomy may help preserve neurological function in the face of otherwise progressive syringomyelia.

Delayed occurrence of spinal arachnoiditis following a caudal block.

CONTEXT: Spinal arachnoiditis is a rare disease caused by fibrosis and adhesion of the arachnoid membrane due to chronic inflammation. The causes of arachnoiditis are infection, spinal surgery, intraspinal injection of steroid or myelography dye, and spinal anesthesia. METHOD: Case report. FINDINGS: A 60-year-old woman presented with progressive weakness and sensory change of both legs and urinary symptoms. She had received a single caudal block 6 months before symptom onset. Magnetic resonance imaging of the thoraco-lumbar spine showed an intradural extramedullary tumor at the T5-T7 level. She underwent laminectomy and tumor resection. The pathological finding was arachnoiditis. After surgery, a rehabilitation program of strengthening exercises of both lower extremities and gait training was started. At 2-month follow-up, she was able to walk with orthoses and performed daily activities with minimal assistance. CONCLUSION: Symptoms of spinal arachnoiditis occurred 6 months after a single caudal block in this woman. Clinicians should be aware of this possible delayed complication.

Optochiasmatic arachnoiditis and neurotuberculosis: prognostic indicators and therapeutic strategies.

Tuberculous meningitis (TBM) is a serious meningitic infection commonly found to occur in the developing countries endemic to tuberculosis. Based on the clinical features alone, the diagnosis of TBM can neither be made nor excluded with certainty. Unfortunately there is still no single diagnostic method that is both sufficiently rapid and sensitive. Most factors found to correlate with poor outcome can be directly traced to the stage of the disease at the time of diagnosis. The only way to reduce the mortality and morbidity is by early diagnosis and timely recognition of complications and institution of the appropriate treatment strategies.

Tuberculosis with meningitis, myeloradiculitis, arachnoiditis and hydrocephalus: a case report.

PURPOSE: Involvement of the central nervous system (CNS) by tuberculosis is rare; it can affect either immunocompromised or immunocompetent people. CASE REPORT: Here, we report a case of tuberculosis with CNS involvement. We present the case of an immunocompetent young man who developed fever, subacute headache, disturbance of consciousness, paraparesis, sphincter dysfunction, and hypoesthesia. The final diagnosis was tuberculous meningitis, myeloradiculitis and arachnoiditis based on clinical signs, imaging studies, and cerebrospinal fluid culture. The patient received antituberculosis medication with adjunct intravenous steroid therapy. Although his clinical condition improved significantly, some neurological sequelae persisted. CONCLUSION: Methods for detection of CNS TB and treatment protocols should be constantly re-evaluated to improve treatment outcome and reduce likelihood and severity of neurological sequelae.

Muslinoma and muslin-induced foreign body inflammatory reactions after surgical clipping and wrapping for intracranial aneurysms: imaging findings and clinical features.

OBJECT: Reinforcement of aneurysms with additional wrapping is an alternative procedure if the aneurysm cannot be completely clipped. Wrapping with muslin (cotton gauze) rarely incites foreign body inflammatory reactions. In this study, the authors describe the clinical and radiological features of muslinomas or muslin-induced foreign body reactions that can develop after treatment of intracranial aneurysms. METHODS: Over a 3-year period, 5 patients with muslinomas underwent treatment at the authors' institution. All patients underwent aneursym clipping and wrapping, and were subsequently readmitted with acute or subacute neurological symptoms. Clinical and imaging features on diffusion weighted MR images and cerebral angiography images were retrospectively reviewed. The patients' clinical course and follow-up imaging studies were also evaluated. RESULTS: In all 5 cases, muslinomas were seen as rim-enhancing inflammatory masses around the clipped aneurysms with perilesional edema visible on MR images at the time of clinical deterioration. The MR images also demonstrated adhesive arachnoiditis with a sterile intracranial abscess in 3 patients, optic neuropathy in 2, parent artery narrowing in 2, and a resultant acute ischemic infarction in 1 patient. Follow-up imaging revealed resolution of both the perilesional edema and adhesive arachnoiditis but no significant changes in the muslinomas. All patients underwent conservative management and fully recovered, but during the follow-up period, 2 patients experienced clinical and radiological relapses. CONCLUSIONS: When a patient with a history of wrapping of an aneurysm presents with acute neurological symptoms and an enhancing intracranial mass in the region of the surgical site on MR imaging, a muslin-induced foreign body inflammatory reaction should be considered in the differential diagnosis, and careful clinical and radiological follow-up is advised.

Lumbar arachnoiditis and thecaloscopy: brief review and proposed treatment algorithm.

The term arachnoiditis describes the inflammation of the meninges and subarachnoid spaces. Lumbar arachnoiditis is characterized by obliterated nerve root sleeves and the adherence of nerve roots to each other in the proximity of the cauda equina, and may be secondary to infectious diseases or tumors, iatrogenic (subsequent to spinal surgery) or idiopathic. It is not very clearly defined epidemiologically or clinically, and various theories regarding its pathophysiology have been proposed; furthermore, its treatment is difficult because there is a lack of evidence-based diagnostic and therapeutic gold standards. Thecaloscopy has been recently described as a novel technique for retrograde transcutaneous neuroendoscopic inspection of the subarachnoid structures of the lumbar thecal sac; it has also been suggested for the treatment of lumbar arachnoiditis. We here review the most modern techniques for the treatment of this disease such as thecaloscopy and neurostimulation.

Postoperative spinal adhesive arachnoiditis presenting with hydrocephalus and cauda equina syndrome.

To our knowledge, the association between hydrocephalus and postoperative spinal adhesive arachnoiditis (SAA) has never been reported. Herein we describe an unusual case of a 45-year-old man with spinal adhesive arachnoiditis (SAA) who developed delayed-onset hypertensive hydrocephalus and cauda equina syndrome (CES) after multiple low-back surgeries. The patient's clinical presentation, imaging findings, surgical management, and the possible mechanisms are discussed in the light of the present literature.

A comprehensive review of spinal arachnoiditis.

Spinal arachnoiditis is an insidious disease caused by an inflammatory process of the arachnoid membrane resulting from many possible causes, such as myelograms with oil-based radiographic contract agents and multiple back surgeries. Diagnosis is based on symptoms and magnetic resonance imaging. Arachnoiditis can also mimic the symptoms of other diseases, such as spinal cord tumors, cauda equina syndrome, arachnoiditis ossificans, and syringomyelia. Unfortunately, there is no cure, only treatment of the chronic symptoms. It is an incurable disease that can cause minor to severe symptoms from unexplained rashes to neurologic defects.

Tuberculous meningitis with spinal tuberculous arachnoiditis.

This report is of a 36-year-old woman who initially presented with confusion and fever. Subsequent investigations showed tuberculous meningitis with acute hydrocephalus. Ventriculoperitoneal shunt was performed and anti-tuberculosis therapy was given. The patient was later noticed to have weakness of both lower limbs and urinary retention. Magnetic resonance imaging of the thoracic spine showed radiological features of tuberculous arachnoiditis with cord compression. Decompressive laminectomy was performed and high-dose systemic corticosteroid was given. A high level of awareness is required when diagnosing tuberculous arachnoiditis and the importance of high-dose corticosteroid in the treatment regimen is emphasised.

[Balneotherapy of children with complications of craniocerebral injuries]. / Bal'neolechenie detei s posledstviiami cherepno-mozgovoi travmy.

Children with aftereffects of craniocerebral trauma have received sanatorium treatment including exercises, massage, mineral baths of different chemical composition. Adequate therapeutic measures taken in due time diminish the number of the aftereffects and their severity.

Symptomatic lumbar spinal arachnoiditis: fact or fallacy?

It is generally accepted that chronic adhesive lumbar arachnoiditis is a cause of symptoms, notably back pain and/or pain (of almost any type, not necessarily 'anatomical') in the lower limbs, although there is no clearly defined clinical pattern which is clearly associated with this syndrome. There is no doubt that arachnoiditis occurs as a pathological and radiological entity due to a number of causes. In the view of the present authors, the nexus between the pathology and radiology on the one hand, and the patients' symptoms on the other hand, has not been demonstrated with any degree of scientific rigor.

Aracnoiditis / Arachnoiditis

La aracnoiditis es un proceso inflamatorio proliferativo no específico que produce un espectro de cambios patológicos que comprometen principalmente los elementos intratecales y conduce a un proceso de enfermedad permanente capaz de causar dolor intratable y deficit neurológico. Puede estar causada por la introducción de la sustancia irritativa de un cuerpo extraño en el espacio subaracnoideo, como: agentes terapéuticos (metrotraxato, antibióticos, etc.), contaminantes químicos (antisépticos), trauma con desgarro dural (sangrado subaracnoideo), tumores que invaden la aracnoides, infecciones en la columna espinal, sangre en el espacio subaracnoideo, sangrado en el momento de la cirugía, parches de sangre epidurales, mielitis aséptica transversal, tinturas solubles en aceite utilizadas para los mielogramas (por ej., iofendilato), algunas tinturas solubles en agua (metrizamida) y trauma quirúrgico (lesión directa a las estructuras neurales). Cuando se utilizan epiduralmente, son seguros los esteroides sin preservativos. La confirmación del diagnóstico de aracnoiditis puede obtenerse mediante RMN (que es el mejor método) de diagnóstico; en ciertos casos pueden ser útiles las radiografías planas de la columna, la exploración por TC, los potenciales somatosensoriales evocados selectivos, EMG y mieloscopía. El estilo de vida de los pacientes con aracnoiditis adhesiva se ve gravemente afectado con el progreso de los síntomas y las discapacidades. Un diagnóstico precoz en este grupo de pacientes le permite al médico tratante establecer cuánta aracnoiditis adhesiva es responsable de los síntomas, porque a menudo otras causas coexistentes deterioran la evolución y el pronóstico de dicha enfermedad. Son necesarios los programas específicos para la rehabilitación psico-social de los pacientes. Las medidas para tratar estos pacientes permitirán al menos una recuperación parcial de sus actividades sociales. Se requiere un esfuerzo multidisciplinario para resolver la complejidad de las manifestaciones de la aracnoiditis adhesiva, así como otras condiciones patológicas frecuentemente asociadas con ésta. Actualmente, la prevención es el objetivo primordial.

Aracnoiditis / Arachnoiditis

La aracnoiditis es un proceso inflamatorio proliferativo no específico que produce un espectro de cambios patológicos que comprometen principalmente los elementos intratecales y conduce a un proceso de enfermedad permanente capaz de causar dolor intratable y deficit neurológico. Puede estar causada por la introducción de la sustancia irritativa de un cuerpo extraño en el espacio subaracnoideo, como: agentes terapéuticos (metrotraxato, antibióticos, etc.), contaminantes químicos (antisépticos), trauma con desgarro dural (sangrado subaracnoideo), tumores que invaden la aracnoides, infecciones en la columna espinal, sangre en el espacio subaracnoideo, sangrado en el momento de la cirugía, parches de sangre epidurales, mielitis aséptica transversal, tinturas solubles en aceite utilizadas para los mielogramas (por ej., iofendilato), algunas tinturas solubles en agua (metrizamida) y trauma quirúrgico (lesión directa a las estructuras neurales). Cuando se utilizan epiduralmente, son seguros los esteroides sin preservativos. La confirmación del diagnóstico de aracnoiditis puede obtenerse mediante RMN (que es el mejor método) de diagnóstico; en ciertos casos pueden ser útiles las radiografías planas de la columna, la exploración por TC, los potenciales somatosensoriales evocados selectivos, EMG y mieloscopía. El estilo de vida de los pacientes con aracnoiditis adhesiva se ve gravemente afectado con el progreso de los síntomas y las discapacidades. Un diagnóstico precoz en este grupo de pacientes le permite al médico tratante establecer cuánta aracnoiditis adhesiva es responsable de los síntomas, porque a menudo otras causas coexistentes deterioran la evolución y el pronóstico de dicha enfermedad. Son necesarios los programas específicos para la rehabilitación psico-social de los pacientes. Las medidas para tratar estos pacientes permitirán al menos una recuperación parcial de sus actividades sociales. Se requiere un esfuerzo multidisciplinario para resolver la complejidad de las manifestaciones de la aracnoiditis adhesiva, así como otras condiciones patológicas frecuentemente asociadas con ésta. Actualmente, la prevención es el objetivo primordial. (AU)