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

Abstract

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.

Management of a recurrent spinal arachnoid cyst presenting as arachnoiditis in the setting of spontaneous spinal subarachnoid hemorrhage: illustrative case

“…To the best of our knowledge, only three other cases of spinal arachnoid cyst formation secondary to spontaneous SSAH without evidence of spinal vascular malformation or intracranial hemorrhage have been reported (Table 1). [13][14][15] The other reported cases involved an intracranial SAH later presenting with a spinal arachnoid cyst. 16 Additionally, there is utility in frequent MRI during the acute presentation phase to monitor the development from hemorrhage to hematoma, to guide surgical decision-making when correlated with the observed clinical symptoms.…”