Immunotherapies in chronic adhesive arachnoiditis - A case series and literature review

Hackert, Jana; Maßmann, Louisa; Sure, Ulrich; Forsting, Michael; Kleinschnitz, Christoph; Pul, Refik; Hagenacker, Tim

doi:10.1016/j.ensci.2021.100350

Cited by 7 publications

(7 citation statements)

References 61 publications

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“…9 In our patient, detethering was not deemed feasible because of the extent of cord tethering. Although systemic steroids can ameliorate symptoms, 10 our patient failed a course of pulsed methylprednisolone. Epidural steroids may increase the risk of adhesive arachnoiditis rather than representing a promising therapy.…”

Section: Sectionmentioning

confidence: 64%

“…Laboratory blood and CSF studies are nonspecific and mainly used to rule out other (e.g., infectious or autoimmune) causes of arachnoiditis. 10,13,14 MRI often shows arachnoid cysts, nerve root clumping or enhancement, cord swelling, and arachnoid septations. 8,15 Snake-eye cord appearance on imaging is nonspecific but may be prognostically unfavorable as it can represent cystic gray matter necrosis.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Reasoning: A 64-Year-Old Man With History of Meningitis Presenting With Proximal Weakness of the Arms

et al. 2022

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A 64-year-old man presented for evaluation of proximally pronounced weakness of the arms with preserved facial and lower extremity strength. Symptoms slowly developed over the last two years, and the patient’s history was notable for severe Listeria monocytogenes meningitis four years prior to presentation, which was adequately treated with antibiotics. On examination, symptoms clinically reassembled ‘man-in-the-barrel’ syndrome and localized to the cervicothoracic central cord. Blood analysis was unremarkable, and CSF analysis showed no recurrent or persistent infection. Spinal MRI revealed pockets of sequestered CSF from C3 to C4 and areas of CSF space effacement from C3 to T12. MRI findings were interpreted as cord tethering suggestive of adhesive arachnoiditis. CT myelogram showed insufficient contrast agent migration above T10 and contour irregularities of the conus medullaris, confirming the postulated pathomechanism of cord tethering. Final diagnosis was therefore cervicothoracic central cord damage due to cord tethering in the setting of postinfectious adhesive arachnoiditis following bacterial meningitis. The patient failed a course of pulsed methylprednisolone therapy, and symptoms progressed. Best supportive care was provided. The clinical presentation of adhesive arachnoiditis is variable, and advanced imaging techniques and invasive studies such as CT myelogram may be required to establish the diagnosis. Timely diagnosis is warranted as early surgical or medical therapy can improve symptoms.

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Section: Sectionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Clinical Reasoning: A 64-Year-Old Man With History of Meningitis Presenting With Proximal Weakness of the Arms

et al. 2022

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“…Surgeries have been done depending on the symptoms and causative pathology. Procedures like expansive duraplasty, microscopic adhesiolysis, myelotomy, intraventricular drain placement, and spondylodesis have been tried [ 18 , 19 ]. However, the long-term outcome of surgical treatment in these cases is not satisfactory.…”

Section: Discussionmentioning

confidence: 99%

“…However, the long-term outcome of surgical treatment in these cases is not satisfactory. Conservative management with corticosteroids has proven to be useful in the early stages of spinal arachnoiditis but not in the later stages [ 19 ]. In our case, we commenced intravenous steroids very early in the disease along with proper antibiotics, which helped in the timely resolution of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous-Onset Delayed Spinal Arachnoiditis With Dorsal Cord Herniation in a 29-Year-Old Paraplegic Patient: A Case Report

Bansal,

Guha,

Gupta

2023

Cureus

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Spinal adhesive arachnoiditis is a rare occurrence with a diverse etiology. The clinical picture is not universal, and varying degrees of neurodeficit have been mentioned. Spontaneous spinal cord herniation or idiopathic spinal cord herniation occurs due to displacement of the cord through a dural or arachnoid defect.We report a case of a 29-year-old male paraplegic patient with a nontraumatic spinal cord injury (SCI) following surgery for an intradural extramedullary lesion at T10-T11 level who developed loss of truncal balance after two years of the index surgery. After a thorough clinical examination and MRI as well as other investigations, the patient was diagnosed as having spontaneous-onset delayed spinal arachnoiditis with dorsal cord herniation through the laminectomy window with effacement of neural tissue and ascending edema up to T6 level.A new-onset weakness or the development of an ascending loss of sensory level with a loss of truncal balance should alarm the therapist about some new pathology happening at the cord level in patients with SCI. In this regard, spinal adhesive arachnoiditis with or without cord herniation should always be suspected in a paraplegic patient with delayed-onset deterioration of neurology. Differential diagnoses like arachnoid web and arachnoid cysts should also be kept in mind.

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“…Medical treatment for arachnoiditis did not show improvement until now. Hackert et al [10] reported improvement in one fourth patient after immunotherapies including corticosteroids, methotrexate, or plasmapheresis but firm clues seem to insufficient. There are several surgical options to treat an arachnoid cyst with adhesive arachnoiditis.…”

Section: Discussionmentioning

confidence: 99%

Multiple recurrent arachnoid cysts with adhesive arachnoiditis following a spontaneous spinal subdural hematoma in an elderly patient: a case report with a literature review

Yang

Ryu

Yoon

et al. 2021

J Korean Soc Geriatr Neurosurg

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Adhesive arachnoiditis in addition to spinal arachnoid cysts is extremely uncommon [1]. It is known to be associated with devastating clinical outcomes. Although the exact pathophysiology associated with an arachnoid cyst remains unclear, congenital, inflammatory, iatrogenic, and post-traumatic factors might play roles in its pathophysiology [2]. Severe diffuse inflammatory reaction along the whole spinal cord can occur rarely after hemorrhage [3]. Adhesion forms tethering of neural component including spinal cord and nerve roots. Subsequently, cerebrospinal fluid (CSF) location due to the disruption of flow is generated. It can compress the spinal cord with a clinical manifestation as progressive motor weakness. Previous reported cases were adhesive arachnoiditis following aneurysmal or spontaneous subarachnoid hemorrhage. In this article, we report a case of a recurrent spinal arachnoid cyst Although arachnoid cysts associated with adhesive arachnoiditis are extremely rare, they can have devastating clinical outcomes. This severe form of arachnoiditis develops from fibrosis of the arachnoid membrane with subsequent adhesion of the arachnoid space. An arachnoid cyst with adhesive arachnoiditis can compress the spinal cord. Surgical decompression can be considered in case of neurologic deficits. However, surgery should be chosen carefully because it does not always guarantee favorable clinical outcomes. We present a case of recurrent arachnoid cysts with adhesive arachnoiditis following a spontaneous spinal hematoma in an elderly woman who suffered from progressive myelopathy despite 2 adhesiolysis treatments.

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Immunotherapies in chronic adhesive arachnoiditis - A case series and literature review

Cited by 7 publications

References 61 publications

Clinical Reasoning: A 64-Year-Old Man With History of Meningitis Presenting With Proximal Weakness of the Arms

Clinical Reasoning: A 64-Year-Old Man With History of Meningitis Presenting With Proximal Weakness of the Arms

Spontaneous-Onset Delayed Spinal Arachnoiditis With Dorsal Cord Herniation in a 29-Year-Old Paraplegic Patient: A Case Report

Multiple recurrent arachnoid cysts with adhesive arachnoiditis following a spontaneous spinal subdural hematoma in an elderly patient: a case report with a literature review

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