Arachnoiditis – A challenge in diagnosis and success in outcome – Case report

Safi, Saleh; Thabat, Abdelnaser; Arshad, Mohamed; Hanoun, Mohamed

doi:10.1016/j.inat.2021.101219

Cited by 7 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is possible that spinal arachnoiditis may develop because of persistent aseptic inflammation in individuals who have previously developed meningitis [ 28 ]. The associated leptomeningeal scarring could trigger a delayed inflammatory fibroproliferative reaction resulting in fibrino-collagenous exudate that adheres the nerve roots to either themselves or the thecal sac (adhesive arachnoiditis) [ 28 , 29 ]. These scarring changes can further induce thrombotic changes in the meningeal and spinal cord vessels, obstructing vascular flow to the spinal cord and resulting in focal ischaemia and necrosis [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Delayed spinal arachnoiditis with syringomyelia following aneurysmal subarachnoid haemorrhage: a case report with patient experience

Jain,

Jaunozolina,

Putraima

et al. 2024

Spinal Cord Ser Cases

View full text Add to dashboard Cite

Background and importance Syringomyelia, or the formation of fluid-filled cysts within the spinal cord, associated with delayed spinal arachnoiditis is an uncommon complication of aneurysmal subarachnoid haemorrhage. To date, about 18 cases have been reported in medical literature, with just two reported in patients under the age of 35 years. Clinical presentation A 27-year-old female patient complained of sudden, severe headaches in the occipital region, nuchal rigidity, and drowsiness when she presented at our institution. A head computed tomography scan revealed intraventricular bleeding in the lateral and fourth ventricles with more extensive haemorrhaging in the frontal horns. A left posterior inferior cerebellar artery (PICA) aneurysm was confirmed via digital subtraction angiogram, and endovascular embolization was done. Two years later, the patient reported intense pain in the lower back along with symptoms suggestive of spinal cord compression. Spinal magnetic resonance imaging (MRI) showed spinal adhesions from C1 to L4, syringomyelia with some vasogenic oedema extending from T3 to T9 level, and a cyst in the lumbar region. Consequently, a right hemilaminectomy was performed along with microsurgical release of arachnoid adhesions and placement of a subdural drain. Radiological and symptomatic improvements were observed. Since then, the patient’s clinical condition has remained stable during the past three years of follow-up visits. Conclusions Literature on optimal treatment modalities and patient prognosis is scarce and debated. The time for symptom improvement depends on the level and extent of spinal cord involvement. Rehabilitation may be required for most patients, as complete symptomatic recovery may not be attainable.

show abstract

Section: Discussionmentioning

confidence: 99%

Delayed spinal arachnoiditis with syringomyelia following aneurysmal subarachnoid haemorrhage: a case report with patient experience

Jain,

Jaunozolina,

Putraima

et al. 2024

Spinal Cord Ser Cases

View full text Add to dashboard Cite

show abstract

“…Research indicates that T2 MRI with true fast imaging and steady-state precession or acquisition sequences can be used to identify and localize adhesive arachnoiditis through MRI [ 19 , 29 ]. The MRI signs associated with adhesive arachnoiditis encompass a range of features, including hydrocephalus, syringomyelia [ 3 , 7 , 13 , 14 ], arachnoid cysts [ 3 , 4 , 5 , 6 , 7 , 8 , 9 ], clumped nerve roots [ 3 , 4 , 7 , 10 ], cord tethering [ 3 , 5 , 9 , 11 , 12 , 13 ], arachnoid septations [ 3 , 6 , 7 , 14 , 15 ], and arachnoiditis ossificans [ 3 ]. These are categorized as localization signs, meaning that they indicate the location of adhesive arachnoiditis, or as associated signs, meaning that they represent the consequences of the condition ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…Overall, surgical treatment generally provides an opportunity to improve or maintain functional outcomes. Research findings on the topic are compiled in Table 2 [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 14 , 15 ]. We conducted an organized review of these articles to offer guidance to physicians who encounter similar cases in the future.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) is widely used to diagnose postoperative adhesive arachnoiditis. MRI findings associated with adhesive arachnoiditis include various features at the adhesive site, such as arachnoid cysts [ 3 , 4 , 5 , 6 , 7 , 8 , 9 ], clumped nerve roots [ 3 , 4 , 7 , 10 ], cord tethering [ 3 , 5 , 9 , 11 , 12 , 13 ], arachnoid septations [ 3 , 6 , 7 , 14 , 15 ], and arachnoiditis ossificans [ 3 ]. Additionally, nonspecific findings in cases of adhesive arachnoiditis may include hydrocephalus and syringomyelia [ 3 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Delta Cord as a Radiological Localization Sign of Postoperative Adhesive Arachnoiditis: A Case Report and Literature Review

Tu,

Chiang,

Lin

2023

Diagnostics

View full text Add to dashboard Cite

Postoperative adhesive arachnoiditis is an inflammatory response of the spinal leptomeninges that occurs after surgery and results in scar formation in the avascular nature of the arachnoid layer. Clinical manifestations of postoperative adhesive arachnoiditis include pain, sensory deficits, motor dysfunction, reflex abnormalities, and bladder or bowel impairment. In magnetic resonance imaging scans, signs of postoperative adhesive arachnoiditis can vary; however, some indicators can assist surgeons in locating the lesion accurately and, thus, in planning effective surgical interventions. This paper reports the case of a 37-year-old man with postoperative adhesive arachnoiditis after two surgeries for Chiari I malformation. This case illustrates the progressive development of the “delta cord sign”, which refers to the formation of a thick arachnoid band causing the spinal cord to adopt a triangular shape in the axial view. This phenomenon is accompanied by the sequential occurrence of syringomyelia. During intraoperative examination, we identified the presence of the delta cord sign, which had been formed by an arachnoid scar that tethered the dorsal spinal cord to the dura. This discovery enabled us to precisely pinpoint the location of the arachnoid scar and thus provided us with guidance that enabled us to avoid unnecessary exploration of unaffected structures during the procedure. Other localization signs were also reviewed.

show abstract

“…Several etiologies have been described in the literature, such as infection, including tuberculosis [ 5 , 13 ], syphilis [ 5 , 13 ], brucellosis [ 14 ], candida [ 13 ], mycosis [ 14 ], and HIV infection [ 2 ]; mechanical causes, including spinal surgery [ 15 ], trauma [ 8 ], and disc herniation [ 8 ]; previous spinal illness, including ankylosing spondylitis [ 5 , 6 ], autoimmune vasculitis [ 2 ], and Guillain-Barré syndrome [ 2 ]; and chemical causes, including morphine [ 16 ], myelograms with oil-based radiographic contrast agents [ 17 , 18 ], sulfite-containing preservatives [ 2 ], phenolic solutions [ 10 ], chlorhexidine [ 19 ], epidural injection of steroids and antibiotics [ 5 ], blood in subarachnoid hemorrhage [ 20 , 21 ] or epidural blood patch [ 22 ], and epidural anesthetics [ 14 , 23 ]. Nevertheless, epidural analgesia in obstetrics using preservative-free, low-concentration bupivacaine with opioids is still not established as a defined cause for AA [ 1 ].…”

Section: Reviewmentioning

confidence: 99%

Spinal Adhesive Arachnoiditis: A Literature Review

Maillard¹,

Batista²,

Medeiros³

et al. 2023

Cureus

View full text Add to dashboard Cite

Adhesive arachnoiditis (AA) is a rare inflammatory and scar-forming disease with several etiologies that may lead to incapacitating sequelae if not managed early. Nevertheless, as the onset of symptoms varies from days to years, the etiology is not often discovered. The disease is characterized by adhesions disrupting the cerebrospinal fluid flow and causing encapsulation and atrophy of the nerve root. Therefore, a range of clinical features may be present, including urinary, gastroenterology, dermatologic, and neurologic. In terms of diagnosis, magnetic resonance imaging is the gold standard showing pseudocysts with adherent and narrow nerve roots toward the center of the dural sac or peripherally cluster and narrow nerve roots with empty thecal sac. Despite its sensitivity and specificity, the imaging findings are not often associated with clinical manifestations, requiring treatment being based on anamneses and clinical findings. Nowadays, AA can be managed with pharmacological and non-pharmacological treatment, although none provides a completely satisfying result.

show abstract

Arachnoiditis – A challenge in diagnosis and success in outcome – Case report

Cited by 7 publications

References 20 publications

Delayed spinal arachnoiditis with syringomyelia following aneurysmal subarachnoid haemorrhage: a case report with patient experience

Delayed spinal arachnoiditis with syringomyelia following aneurysmal subarachnoid haemorrhage: a case report with patient experience

Delta Cord as a Radiological Localization Sign of Postoperative Adhesive Arachnoiditis: A Case Report and Literature Review

Spinal Adhesive Arachnoiditis: A Literature Review

Contact Info

Product

Resources

About