Iodized Oils as an AID to the Diagnosis of Lesions of Tihe Spinal Cord and a Contribution to the Knowledge of Adhesive Circumscribed Meningitis

Odin, Martin; Runström, Gösta

doi:10.3109/00016922809136774

Cited by 16 publications

(4 citation statements)

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“…Intraspinal benign arachnoid cysts may be confidently diagnosed myelographically when there is complete or partial obstruction to flow of contrast medium with multiple oily contrast/cerebrospinal fluid levels as in CASES I,ll and III in this series. However, the cysts may not fill with contrast, and myelographically it may be impossible to differentiate them from other space-occupying lesions (17). If all of the oily contrast medium is not aspirated at the conclusion of the myelogram, restudy after 24 hours may be of value in allowing the cysts to fill.…”

mentioning

confidence: 98%

Spinal Arachnoid Cysts in Children

Duncan¹,

Hoare²

1978

Radiology

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Five cases of benign spinal arachnoid cysts in children are described with their clinical, neuroradiological, surgical and pathological findings. Intraspinal benign arachnoid cysts may be confidently diagnosed myelographically when there is complete or partial obstruction with multiple oily contrast/cerebrospinal fluid levels as in 3 cases in this series. The multiple fluid levels are probably produced by multiple cysts or a cyst loculated due to partial compression by arachnoid bands either related to the normal septum posticum, congenital or acquired adhesion rather than to trabeculations within the cyst. In this series, the origin of the cysts is considered to be congenital.

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confidence: 98%

Spinal Arachnoid Cysts in Children

Duncan¹,

Hoare²

1978

Radiology

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“…There were 71 studies containing 3255 patients spanning from 1928-2020. The earliest study reported was the use of iodized oils to image "lesions of the spinal cord" from the research and translational lab producing them in Stockholm [350]. The earliest article on imaging and suggested treatment of arachnoiditis via air injection was published in 1942 [658].…”

Section: Diagnostic Studies For Dlmsmentioning

confidence: 99%

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

Palackdkharry¹,

Wottrich²,

Dienes³

et al. 2022

PLoS ONE

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Background & importance This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare “iatrogenic chronic meningitis” causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. Methods The prospective PRISMA protocol is published at Arcsology.org. We used four platforms, 10 sources, extraction software, and critical review with ≥2 researchers at each phase. All human sources to 12/6/2020 were eligible for qualitative synthesis utilizing R. Weekly updates since cutoff strengthen conclusions. Results Included were 887/14286 sources containing 12721 DLMs patients. Pathology involves the subarachnoid space (SAS) and pia. DLMs occurred in all countries as a contributor to the top 10 causes of disability-adjusted life years lost, with communicable diseases (CDs) predominating. In the USA, the ratio of CDs to iatrogenic causes is 2.4:1, contradicting arachnoiditis literature. Spinal fusion surgery comprised 54.7% of the iatrogenic category, with rhBMP-2 resulting in 2.4x more DLMs than no use (p<0.0001). Spinal injections and neuraxial anesthesia procedures cause 1.1%, and 0.2% permanent DLMs, respectively. Syringomyelia, hydrocephalus, and arachnoid cysts are complications caused by blocked CSF flow. CNS neuron death occurs due to insufficient arterial supply from compromised vasculature and nerves traversing the SAS. Contrast MRI is currently the diagnostic test of choice. Lack of radiologist recognition is problematic. Discussion & conclusion DLMs are common. The LM clinically functions as an organ with critical CNS-sustaining roles involving the SAS-pia structure, enclosed cells, lymphatics, and biologic pathways. Cases involve all specialties. Causes are numerous, symptoms predictable, and outcomes dependent on time to treatment and extent of residual SAS damage. An international disease classification and possible treatment trials are proposed.

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“…Although myelography was first performed with lipiodol by Siccard and Forestier in 1922 (21), the use of this technique was carried out with caution because it was soon noted to produced severe reactions (22), even when more refined water soluble dyes such as Abradil, Dimer X, Thorotrast, and others were tried (23). Pantopaque (ethyliodophenylundecilate) was introduced by Ramsey et al .…”

Section: Introductionmentioning

confidence: 99%

Neurologic deficits and arachnoiditis following neuroaxial anesthesia

Aldrete¹

2002

Acta Anaesthesiol Scand

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Of late, regional anesthesia has enjoyed unprecedented popularity; this increase in cases has brought a higher frequency of instances of neurological deficit and arachnoiditis that may appear as transient nerve root irritation, cauda equina, and conus medullaris syndromes, and later as radiculitis, clumped nerve roots, fibrosis, scarring dural sac deformities, pachymeningitis, pseudomeningocele, and syringomyelia, etc., all associated with arachnoiditis. Arachnoiditis may be caused by infections, myelograms (mostly from oil-based dyes), blood in the intrathecal space, neuroirritant, neurotoxic and/or neurolytic substances, surgical interventions in the spine, intrathecal corticosteroids, and trauma. Regarding regional anesthesia in the neuroaxis, arachnoiditis has resulted from epidural abscesses, traumatic punctures (blood), local anesthetics, detergents, antiseptics or other substances unintentionally injected into the spinal canal. Direct trauma to nerve roots or the spinal cord may be manifested as paraesthesia that has not been considered an injurious event; however, it usually implies dural penetration, as there are no nerve roots in the epidural space posteriorly. Sudden severe headache while or shortly after an epidural block using the loss of resistance to air approach usually suggests pneumocephalus from an intradural injection of air. Burning severe pain in the lower back and lower extremities, dysesthesia and numbness not following the usual dermatome distribution, along with bladder, bowel and/or sexual dysfunction, are the most common symptoms of direct trauma to the spinal cord. Such patients should be subjected to a neurological examination followed by an MRI of the effected area. Further spinal procedures are best avoided and the prompt administration of IV corticosteroids and NSAIDs need to be considered in the hope of preventing the inflammatory response from evolving into the proliferative phase of arachnoiditis.

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Iodized Oils as an AID to the Diagnosis of Lesions of Tihe Spinal Cord and a Contribution to the Knowledge of Adhesive Circumscribed Meningitis

Cited by 16 publications

References 0 publications

Spinal Arachnoid Cysts in Children

Spinal Arachnoid Cysts in Children

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

Neurologic deficits and arachnoiditis following neuroaxial anesthesia

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