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Palackdkharry CS, Wottrich S, Dienes E, Bydon M, Steinmetz MP, Traynelis VC. The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis). PLoS One 2022; 17:e0274634. [PMID: 36178925 PMCID: PMC9524710 DOI: 10.1371/journal.pone.0274634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
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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Affiliation(s)
| | - Stephanie Wottrich
- Case Western Reserve School of Medicine, Cleveland, Ohio, United States of America
| | - Erin Dienes
- Arcsology®, Mead, Colorado, United States of America
| | - Mohamad Bydon
- Department of Neurologic Surgery, Orthopedic Surgery, and Health Services Research, Mayo Clinic School of Medicine, Rochester, Minnesota, United States of America
| | - Michael P. Steinmetz
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine Neurologic Institute, Cleveland, Ohio, United States of America
| | - Vincent C. Traynelis
- Department of Neurosurgery, Rush University School of Medicine, Chicago, Illinois, United States of America
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Bressington MJ, Zilani G, Shastin D, Patel C. Unexplained paraparesis following subarachnoid haemorrhage. BMJ Case Rep 2019; 12:12/2/e227666. [PMID: 30819681 DOI: 10.1136/bcr-2018-227666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spinal arachnoid cysts (SAC) are rare in isolation and the exact aetiology is still debated. Primary (congenital) cysts are caused by structural abnormalities in the arachnoid layer and largely affect the thoracic region. Secondary cysts are induced by a multitude of factors, infection, trauma or iatrogenic response, and can affect any level of the spinal cord. While subarachnoid haemorrhage (SAH) is a relatively common condition with significant repercussions, it is extremely uncommonly associated with SAC. When present, it may develop in the months and years after the original bleed, giving rise to new neurological symptoms. Prompt treatment is needed to halt or reverse the worsening of symptoms and questions are still being asked about how best to approach this condition. A 42-year-old man presented with chronic back pain, severe worsening ataxia and numbness below the umbilicus, 7 months after treatment for a World Federation of Neurosurgical Societies grade five (WFNS V) SAH. Imaging revealed a SAC extending from T12 to L4 and causing thecal compression. This was treated with a L3 laminectomy andmarsupialisation. An improvement in neurological function was observed at 6 months. Aetiology of the SAC and its association with SAH are discussed and a review of the relevant literature is provided.
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Affiliation(s)
| | - Gulam Zilani
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Dmitri Shastin
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK.,School of Medicine, Cardiff University, Cardiff, UK
| | - Chirag Patel
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
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Cervicothoracic arachnoiditis—a rare complication of aneurysmal intracranial subarachnoid haemorrhage. Spinal Cord Ser Cases 2018; 4:57. [DOI: 10.1038/s41394-018-0089-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 11/08/2022] Open
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Velz J, Fierstra J, Regli L, Germans MR. Spontaneous Spinal Subarachnoid Hemorrhage with Development of an Arachnoid Cyst—A Case Report and Review of the Literature. World Neurosurg 2018; 119:374-380. [DOI: 10.1016/j.wneu.2018.08.108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 11/15/2022]
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Spinal adhesive arachnoiditis following the rupture of an Adamkiewicz aneurysm: Literature review and a case illustration. Neurochirurgie 2018; 64:177-182. [DOI: 10.1016/j.neuchi.2017.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/06/2017] [Accepted: 11/27/2017] [Indexed: 02/04/2023]
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Zuev AA, Epifanov DS. [Treatment of patients with ossifying arachnoiditis and progressive syringomyelia (analysis of three cases and a literature review)]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018; 82:71-80. [PMID: 29795089 DOI: 10.17116/oftalma201882271-80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To date, only 12 cases of ossifying arachnoiditis with concomitant syringomyelia have been reported in the world literature. In this article, we presented our experience of treating three patients with syringomyelia associated with ossifying arachnoiditis. OBJECTIVE based on the literature data and our own experience, we tried to define the most optimal treatment approach for this disease. MATERIAL AND METHODS We analyzed the data of 15 patients (12 cases reported in the literature and 3 our own cases). The diagnosis was established on the basis of complaints, medical history, patient examination, MRI and CT of the spinal cord, and intraoperative data. Progression of syringomyelia was evaluated by comparison of the neurological status and calculation of the Vaquero index before and after surgery; the Domenicucci classification was used to evaluate the severity of ossifying arachnoiditis. Surgical treatment included several stages: decompressive laminectomy, elimination of spinal cord fixation, excision of ossifying arachnoiditis, shunting of the syrinx, and repair of the dura mater. RESULTS An analysis of the patient data reported in the literature (12 cases) and those in our series (3) revealed that in the early postoperative period, 7 (46.7%) of these 15 patients had improvements, 5 (33.3%) patients had no changes, and 3 (20%) patients experienced a worsening. At present, there is no clear algorithm for diagnosing and treating this disease. CONCLUSION Further investigation of the problem may facilitate an earlier diagnosis of the disease and provide more effective medical care.
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Affiliation(s)
- A A Zuev
- Pirogov National Medical Surgical Center, Nizhnyaya Pervomayskaya Str., 70, Moscow, Russia, 105203
| | - D S Epifanov
- Pirogov National Medical Surgical Center, Nizhnyaya Pervomayskaya Str., 70, Moscow, Russia, 105203
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7
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Basaran R, Kaksi M, Efendioglu M, Onoz M, Balkuv E, Kaner T. Spinal arachnoid cyst associated with arachnoiditis following subarachnoid haemorrhage in adult patients: A case report and literature review. Br J Neurosurg 2014; 29:285-9. [DOI: 10.3109/02688697.2014.976175] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Landi A, Nigro L, Marotta N, Mancarella C, Donnarumma P, Delfini R. Syringomyelia associated with cervical spondylosis: A rare condition. World J Clin Cases 2013; 1:111-115. [PMID: 24303479 PMCID: PMC3845911 DOI: 10.12998/wjcc.v1.i3.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 04/11/2013] [Accepted: 05/17/2013] [Indexed: 02/05/2023] Open
Abstract
Spinal spondylosis is an extremely common condition that has only rarely been described as a cause of syringomyelia. We describe a case of syringomyelia associated with cervical spondylosis admitted at our division and treated by our institute. It is the case of a 66-year-old woman. At our observation she was affected by moderate-severe spastic tetraparesis. T2-weighted magnetic resonance imaging (MRI) showed an hyperintense signal within spinal cord from C3 to T1 with a more sharply defined process in the inferior cervical spinal cord. At the same level bulging discs, facets and ligamenta flava hypertrophy determined a compression towards subarachnoid space and spinal cord. Spinal cord compression was more evident in hyperextension rather than flexion. A 4-level laminectomy and subsequent posterior stabilization with intra-articular screws was executed. At 3-mo follow up there was a regression of tetraparesis but motor deficits of the lower limbs residuated. At the same follow up postoperative MRI was executed. It suggested enlargement of the syrinx. Perhaps hyperintensity within spinal cord appeared “bounded” from C3 to C7 with clearer margins. At the level of surgical decompression, subarachnoid space and spinal cord enlargement were also evident. A review of the literature was executed using PubMed database. The objective of the research was to find an etiopathological theory able to relate syringomyelia with cervical spondylosis. Only 6 articles have been found. At the origin of syringomyelia the mechanisms of compression and instability are proposed. Perhaps other studies assert the importance of subarachnoid space regard cerebrospinal fluid (CSF) dynamic. We postulate that cervical spine instability may be the cause of multiple microtrauma towards spinal cord and consequently may damage spinal cord parenchyma generating myelomalacia and consequently syrinx. Otherwise the hemorrhage within spinal cord central canal can cause an obstruction of CSF outflow, finally generating the syrinx. On the other hand in cervical spondylosis the stenotic elements can affect subarachnoid space. These elements rubbing towards spinal cord during movements of the neck can generate arachnoiditis, subarachnoid hemorrhages and arachnoid adhesions. Analyzing the literature these “complications” of cervical spondylosis are described at the origin of syringomyelia. So surgical decompression, enlarging medullary canal prevents rubbings and contacts between the bone-ligament structures of the spine towards spinal cord and subarachnoid space therefore syringomyelia. Perhaps stabilization is also necessary to prevent instability of the cervical spine at the base of central cord syndrome or syringomyelia. Finally although patients affected by central cord syndrome are usually managed conservatively we advocate, also for them, surgical treatment in cases affected by advanced state of the symptoms and MRI.
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9
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Kobayashi S, Kato K, Rodríguez Guerrero A, Baba H, Yoshizawa H. Experimental syringohydromyelia induced by adhesive arachnoiditis in the rabbit: changes in the blood-spinal cord barrier, neuroinflammatory foci, and syrinx formation. J Neurotrauma 2012; 29:1803-16. [PMID: 22439613 DOI: 10.1089/neu.2011.2259] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There are many histological examinations of syringohydromyelia in the literature. However, there has been very little experimental work on blood permeability in the spinal cord vessels and ultrastructural changes. We prepared an animal model of spinal adhesive arachnoiditis by injecting kaolin into the subarachnoid space at the eighth thoracic vertebra of rabbits. The animals were evaluated 4 months later. Of the 30 rabbits given kaolin injection into the cerebrospinal fluid, 23 showed complete circumferential obstruction. In the 7 animals with partial obstruction of the subarachnoid space, intramedullary changes were not observed. However, among the 23 animals showing complete obstruction of the subarachnoid space, dilatation of the central canal (hydromyelia) occurred in 21, and intramedullary syrinx (syringomyelia) was observed in 11. In animals with complete obstruction, fluorescence microscopy revealed intramedullary edema around the central canal, extending to the posterior columns. Electron microscopy of hydromyelia revealed a marked reduction of villi on the ependymal cells, separation of the ependymal cells, and cavitation of the subependymal layer. The dilated perivascular spaces indicate alterations of fluid exchange between the subarachnoid and extracellular spaces. Syringomyelia revealed that nerve fibers and nerve cells were exposed on the surface of the syrinx, and necrotic tissue was removed by macrophages to leave a syrinx. Both pathologies differ in their mechanism of development: hydromyelia is attributed to disturbed reflux of cerebrospinal fluid, while tissue necrosis due to disturbed intramedullary blood flow is considered to be involved in formation of the syrinx in syringomyelia.
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Affiliation(s)
- Shigeru Kobayashi
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, The University of Fukui, Matsuoka, Fukui, Japan.
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Koyanagi I, Iwasaki Y, Hida K, Houkin K. Clinical features and pathomechanisms of syringomyelia associated with spinal arachnoiditis. ACTA ACUST UNITED AC 2005; 63:350-5; discussion 355-6. [PMID: 15808720 DOI: 10.1016/j.surneu.2004.05.038] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2004] [Accepted: 05/26/2004] [Indexed: 12/23/2022]
Abstract
BACKGROUND Syringomyelia is a common intramedullary lesion associated with spinal arachnoiditis and obstruction of the foramen magnum such as in Chiari's malformation. Disturbance of cerebrospinal fluid flow around the spinal cord has an important role in the development of syringomyelia due to spinal arachnoiditis; however, the exact mechanisms have not been clarified. The purpose of this retrospective study is to understand the clinical features and pathomechanisms of syringomyelia secondary to spinal arachnoiditis and to provide the current choice of surgical treatment in this difficult clinical entity. METHODS Clinical and radiological findings in 15 patients with syringomyelia associated with spinal arachnoiditis who underwent surgical treatment in our institutes between 1982 and 2000 were reviewed. All patients presented with paraparesis or tetraparesis on admission. RESULTS Magnetic resonance imaging (MRI) or computed tomography-myelography revealed that the syrinx predominantly existed at the thoracic levels. Five patients showed complete block of the thoracic subarachnoid space by conventional myelography. T2-weighted MRI showed diffuse intramedullary hyperintensity at the level of arachnoiditis. As the first surgical treatment, 10 patients underwent syringo-peritoneal shunt placement. Three patients were treated with a syringo-subarachnoid shunt, and 2 patients were treated with a ventriculoperitoneal shunt. Eight patients required further shunting operations for syringomyelia 2 months to 12 years after the first surgery. Neurologic improvement was obtained in 9 patients (60%) with decreased size of the syrinx. One patient remained stable; 5 patients showed gradual deterioration. CONCLUSIONS The syrinx originated from the thoracic levels where severe adhesion of the subarachnoid space was present. The mechanisms of syrinx formation may be based on the increased interstitial fluid in the spinal cord. Shunting procedures were effective in some population of the patients. Decompression procedures of the spinal subarachnoid space may be an alternative primary surgical treatment except for patients with longitudinally extensive arachnoiditis.
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Affiliation(s)
- Izumi Koyanagi
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo 060-8543, Japan.
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11
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Aschenbach R, Eger C, Krüger J, Basche S. [Intraspinal cystic space occupying lesion after cranial subarachnoid hemorrhage]. Radiologe 2005; 45:838-41. [PMID: 15657769 DOI: 10.1007/s00117-004-1168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R Aschenbach
- Institut für Bildgebende Diagnostik, HELIOS-Klinikum Erfurt GmbH.
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12
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Abstract
It has been suggested that obstetric epidurals lead to chronic adhesive arachnoiditis (CAA). CAA is a nebulous disease entity with much confusion over its symptomatology. This review outlines the pathological, clinical, and radiological features of the disease. The proposed diagnostic criteria for CAA are: back pain that increases on exertion, with or without leg pain; neurological abnormality on examination; and characteristic MRI findings. Using these criteria, there is evidence to show that epidural or subarachnoid placement of some contrast media, preservatives and possibly vasoconstrictors, may lead to CAA. No evidence was found that the preservative-free, low concentration bupivacaine with opioid mixtures or plain bupivacaine currently used in labour lead to CAA.
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Affiliation(s)
- I Rice
- Shackelton Department of Anaesthesia, Southampton General Hospital, Tremona Road, Shirley, Southampton SO14 6YD, UK.
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13
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Kahler RJ, Knuckey NW, Davis S. Arachnoiditis ossificans and syringomyelia: a unique case report. J Clin Neurosci 2000; 7:66-8. [PMID: 10847657 DOI: 10.1054/jocn.1998.0144] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 62-year-old male presented with progressive quadriparesis. Magnetic resonance imaging of the spine revealed a spinal cord syrinx but failed to detect extensive arachnoiditis ossificans noted on insertion of a syringopleural shunt. A postoperative computed tomography scan clearly demonstrated the abnormality and its extent. We present a rare case of syringomyelia resulting from spinal arachnoiditis ossificans and review the relevant literature.
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Affiliation(s)
- R J Kahler
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Queen Elizabeth II Site, Perth W.A., Australia.
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14
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Slavin KV, Nixon RR, Nesbit GM, Burchiel KJ. Extensive arachnoid ossification with associated syringomyelia presenting as thoracic myelopathy. Case report and review of the literature. J Neurosurg 1999; 91:223-9. [PMID: 10505510 DOI: 10.3171/spi.1999.91.2.0223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present the case of progressive thoracic myelopathy caused by the extensive ossification of the arachnoid membrane and associated intramedullary syrinx. Based on their findings and results of the literature search, they describe a pathological basis for this rare condition, discuss its incidence and symptomatology, and suggest a simple classification for various types of the arachnoid ossification. They also discuss the magnetic resonance imaging features of arachnoid ossification and associated spinal cord changes. The particular value of plain computerized tomography, which is highly sensitive in revealing intraspinal calcifications and ossifications, in the diagnostic evaluation of patients with a clinical picture of progressive myelopathy is emphasized.
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Affiliation(s)
- K V Slavin
- Department of Neurological Surgery, Oregon Health Sciences University, Portland 97201-3098, USA.
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15
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Van den Bergh R. Pathogenesis and treatment of delayed post-traumatic syringomyelia. Acta Neurochir (Wien) 1991; 110:82-6. [PMID: 1882724 DOI: 10.1007/bf01402052] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The role of trauma in the pathogenesis of syringomyelia has been known for a long time. Repeated microtraumata have been considered to play a role in triggering the classical syringomyelia on the basis of a congenital predisposition. It has been proven that post-traumatic arachnoiditis can cause cavitation in the spinal cord and probably syringomyelia stricto sensu as well. The delayed appearance of syringomyelia after a severe single spinal trauma resulting in contusion of the spinal cord without the complication of arachnoiditis is a more recent issue, but is now well-known. Delayed syringomyelia after a minor single spinal trauma, with at first complete recovery, is extremely rare, and is probably often disregarded as a diagnosis. Having studied such a case, with complete neuroradiological work-up, we want to draw attention to the pathogenetic aspects and the possibilities for treatment, of which the syringoperitoneal shunt seems to be the most efficient one.
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Affiliation(s)
- R Van den Bergh
- Department of Neurology and Neurosurgery, Catholic University of Leuven, Belgium
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Abstract
Five patients with chronic arachnoiditis and syringomyelia were studied. Three patients had early life meningitis and developed symptoms of syringomyelia eight, 21, and 23 years after the acute infection. One patient had a spinal dural thoracic AVM and developed a thoracic syrinx 11 years after spinal subarachnoid haemorrhage and five years after surgery on the AVM. A fifth patient had tuberculous meningitis with transient spinal cord dysfunction followed by development of a lumbar syrinx seven years later. Arachnoiditis can cause syrinx formation by obliterating the spinal vasculature causing ischaemia. Small cystic regions of myelomalacia coalesce to form cavities. In other patients, central cord ischaemia mimics syringomyelia but no cavitation is present. Scar formation with spinal block leads to altered dynamics of cerebrospinal fluid (CSF) flow and contributes to the formation of spinal cord cystic cavities.
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Affiliation(s)
- L R Caplan
- Department of Neurology, Michael Reese Hospital
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17
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Augustijn P, Vanneste J, Davies G. Chronic spinal arachnoiditis following intracranial subarachnoid haemorrhage. Clin Neurol Neurosurg 1989; 91:347-50. [PMID: 2555097 DOI: 10.1016/0303-8467(89)90013-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A 54-year-old woman presented with progressive gait imbalance and increased urinary frequency, associated with spinal arachnoiditis. The symptoms started after the occurrence of communicating hydrocephalus as a sequel of subarachnoid haemorrhage (SAH), and were initially attributed to post-SAH vasospasm, decompensating hydrocephalus and/or periventricular leuko-encephalopathy. Further clinical deterioration led to the diagnosis of thoracic spinal arachnoiditis, as a second complication of SAH.
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Affiliation(s)
- P Augustijn
- Department of Neurology, St. Lucas Ziekenhuis, Amsterdam, The Netherlands
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18
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Tjandra JJ, Varma TR, Weeks RD. Spinal arachnoiditis following subarachnoid haemorrhage. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1989; 59:84-7. [PMID: 2913997 DOI: 10.1111/j.1445-2197.1989.tb01470.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Two cases of chronic adhesive spinal arachnoiditis following documented subarachnoid haemorrhage (SAH) are reported. Both cases progressed to severe spinal cord dysfunction with paraplegia. It is hoped that this case report will highlight this uncommon but extremely disabling complication of SAH.
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Affiliation(s)
- J J Tjandra
- Department of Neurosurgery, University Hospital of Wales, Health Park, Cardiff, United Kingdom
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Jenik F, Tekle-Haimanot R, Hamory BH. Non-traumatic adhesive arachnoiditis as a cause of spinal cord syndromes. Investigation of 507 patients. PARAPLEGIA 1981; 19:140-54. [PMID: 7254893 DOI: 10.1038/sc.1981.31] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Spinal cord syndromes with a mainly syringomyelic pattern of sensory diorders, radiculopathies, mixed paresis of varying degree (without any history of trauma), have been found in 507 out of 1305 new patients referred to out Clinic from January 1976 till 31 October 1977. In 105 randomised and unselected cases with these syndromes, myelographies have disclosed findings compatible with an adhesive spinal and/or cisternal arachnoiditis. A prospective study of the syndromes for evidence of infectious aetiology has been performed, in which tuberculosis, syphilis and other infections appear to be causative agents. A randomised therapeutic trial on a limited number of cases has been evaluated, as well as the results of specific therapy in a larger number of cases. Results of treatment have not been satisfactory. Operations were performed on only five patients and in no case was an autopsy obtained. Spinal cord syndromes due to non-traumatic adhesive arachnoiditis are discussed. The possible pathogenetic mechanisms the predominantly syringomyelic sensory deficits in those syndromes are briefly mentioned.
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Williams B, Bentley J. Experimental communicating syringomyelia in dogs after cisternal kaolin injection. Part 1. Morphology. J Neurol Sci 1980; 48:93-107. [PMID: 7420128 DOI: 10.1016/0022-510x(80)90153-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Intracisternal kaolin injection in dogs usually produces hydrocephalus and out of 16 such dogs 11 have shown enlargement of the central canal of the spinal cord which has proceeded to syringomyelia-like cavities in 7 instances. The morphology of the cavities is described, the absence of ischaemic changes in the cord noted and the occasional communication of the cavities with the spinal subarachnoid space at the level of the filum terminale confirmed. The similarities to human syringomyelia are noted together with important differences in the etiology. The dogs all had arachnoiditis, all had hydrocephalus and all had a radiologically demonstrable communication of the cavities with the 4th ventricle, findings which are unusual in human syringomyelia.
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21
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Nagpal RD, Gokhale SD, Parikh VR. Ossification of spinal arachnoid with unrelated syringomyelia. Case report. J Neurosurg 1975; 42:222-5. [PMID: 803555 DOI: 10.3171/jns.1975.42.2.0222] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A case demonstrating a combination of ossified spinal arachnoid and syringomyelia is reported. A plea is made for denoting the condition as "ossification of the spinal arachnoid" rather than "spinal arachnoiditis ossificans".
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Abstract
Acute cord cavities have been produced by injection of saline or cerebrospinal fluid into the spinal cords of five beagle dogs. The lesions resemble syringomyelia as seen in the human. The lesions are described and the significance of the findings in supporting a hydrodynamic concept for communicating syringomyelia in the human are discussed.
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Appleby A, Bradley WG, Foster JB, Hankinson J, Hudgson P. Syringomyelia due to chronic arachnoiditis at the foramen magnum. J Neurol Sci 1969; 8:451-64. [PMID: 5807283 DOI: 10.1016/0022-510x(69)90005-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Shimomura Y, Hukuda S, Mizuno S. Experimental study of ischemic damage to the cervical spinal cord. J Neurosurg 1968; 28:565-81. [PMID: 5671293 DOI: 10.3171/jns.1968.28.6.0565] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Wolman L. The neuropathological effects resulting from the intrathecal injection of chemical substances. PARAPLEGIA 1966; 4:97-115. [PMID: 6013203 DOI: 10.1038/sc.1966.9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Pool JL. The Differential Diagnosis of Spinal Cord Lesions. Surg Clin North Am 1949; 29:521-37. [DOI: 10.1016/s0039-6109(16)32698-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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