Arachnoiditis: Difference between revisions
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The phenomenon of adhesive arachnoiditis was first described by Quinke in 1893 in a case report. In 1897, Schwarz wrote about signs and symptoms of arachnoiditis caused by syphilis. Elkington wrote about the classic description of arachnoiditis in 1936 and termed it as meningitis serosa circumscripta spinalis. He also described various presentations of arachnoiditis in 1951. Foix and Alajouanine described a noninfectious spinal arachnoid scar reaction in 1926 and termed it as hypertrophic vascular ascending myelitis. Ransome and Monterio mentioned that tuberculous meningitis might present as extensive spinal arachnoiditis. The first case of arachnoiditis was associated with syphilis.<ref>Elkington, J. St. C. (1951). Arachnoiditis. In Modern Trends in Neurology, ed. Anthony Feiling, ch. 5, pp. 149-161. Butterworths, London.</ref><ref>ELKINGTON, J. St. C. (1936). [https://doi.org/10.1093/brain/59.2.181 Meningitis serosa circumscripta spinalis (spinal arachnoiditis)]. Brain, 59, 181-203</ref><ref>Foix C, Alajouanine T . La myélite nécrotique subaigue. ''Rev Neurol (Paris)'' 1926; 2: 1–42.</ref><br /> | The phenomenon of adhesive arachnoiditis was first described by Quinke in 1893 in a case report. In 1897, Schwarz wrote about signs and symptoms of arachnoiditis caused by syphilis. Elkington wrote about the classic description of arachnoiditis in 1936 and termed it as meningitis serosa circumscripta spinalis. He also described various presentations of arachnoiditis in 1951. Foix and Alajouanine described a noninfectious spinal arachnoid scar reaction in 1926 and termed it as hypertrophic vascular ascending myelitis. Ransome and Monterio mentioned that tuberculous meningitis might present as extensive spinal arachnoiditis. The first case of arachnoiditis was associated with syphilis.<ref>Elkington, J. St. C. (1951). Arachnoiditis. In Modern Trends in Neurology, ed. Anthony Feiling, ch. 5, pp. 149-161. Butterworths, London.</ref><ref>ELKINGTON, J. St. C. (1936). [https://doi.org/10.1093/brain/59.2.181 Meningitis serosa circumscripta spinalis (spinal arachnoiditis)]. Brain, 59, 181-203</ref><ref>Foix C, Alajouanine T . La myélite nécrotique subaigue. ''Rev Neurol (Paris)'' 1926; 2: 1–42.</ref><br /> | ||
==Classification== | ==Classification== | ||
'''The radiologists classify arachnoiditis, according to Delamarter's MRI classification.''' | |||
• Type I—appears as an adhesive mass of adherent roots centrally in the thecal sac, considered mild arachnoiditis. | |||
• Type II—the empty sac, the roots adhere peripherally to the meninges. | |||
• Type III—a soft-tissue mass replaces the subarachnoid space. | |||
<br /> | |||
==Pathophysiology== | ==Pathophysiology== | ||
Revision as of 17:26, 24 June 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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Overview
Arachnoiditis is a term used to describe thickening, inflammation, and scaring of the arachnoid membrane, which is the middle layer surrounding the central nervous system. These abnormalities may be self-limited or may cause compression of the nerve roots and spinal cord. Patients may report a variety of clinical symptoms, including severe back pain that persists at rest, perineal/saddle numbness, neurological deficits, skin rashes, and sympathetic or vascular changes. The cause of arachnoiditis is unknown but may occur as a result of invasion (surgery), neuraxial injections, certain myelograms, infections, blood, a herniated disc, or tumors. Diagnosis is based on symptoms, and magnetic resonance imaging. Unfortunately, the treatment of arachnoiditis is difficult and limited and should focus on symptomatic management.
Historical Perspective
The phenomenon of adhesive arachnoiditis was first described by Quinke in 1893 in a case report. In 1897, Schwarz wrote about signs and symptoms of arachnoiditis caused by syphilis. Elkington wrote about the classic description of arachnoiditis in 1936 and termed it as meningitis serosa circumscripta spinalis. He also described various presentations of arachnoiditis in 1951. Foix and Alajouanine described a noninfectious spinal arachnoid scar reaction in 1926 and termed it as hypertrophic vascular ascending myelitis. Ransome and Monterio mentioned that tuberculous meningitis might present as extensive spinal arachnoiditis. The first case of arachnoiditis was associated with syphilis.[1][2][3]
Classification
The radiologists classify arachnoiditis, according to Delamarter's MRI classification.
• Type I—appears as an adhesive mass of adherent roots centrally in the thecal sac, considered mild arachnoiditis.
• Type II—the empty sac, the roots adhere peripherally to the meninges.
• Type III—a soft-tissue mass replaces the subarachnoid space.
Pathophysiology
Causes
Causes by Organ System
| Cardiovascular | No underlying causes |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Cytarabine, Cytarabine liposome, Iodixanol |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | No underlying causes |
| Musculoskeletal/Orthopedic | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional/Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal/Electrolyte | No underlying causes |
| Rheumatology/Immunology/Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Causes in Alphabetical Order
- List the causes of the disease in alphabetical order. You may need to list across the page, as seen here
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Differentiating Arachnoiditis from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History
Complications
Prognosis
Arachnoiditis is a chronic disorder and there is no known cure at this time. Pain management techniques may provide some relief to patients. Prognosis may be hard to determine because of the lack of correlation between the beginning of the disease and the start of symptoms. For many, arachnoiditis is a disabling disease that causes chronic pain and neurological deficits. It may also lead to other spinal cord conditions, such as syringomyelia.
Diagnosis
Diagnostic Criteria
History and Symptoms
The swollen arachnoid can lead to a host of painful and debilitating symptoms. Chronic pain is common, including neuralgia. Numbness and tingling of the extremities is frequent in patients due to spinal cord involvement. Bowel, bladder, and sexual functioning can be affected if the lower part of the spinal cord is affected. While arachnoiditis has no consistent pattern of symptoms, it frequently affects the nerves that supply the legs and lower back.
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Arachnoiditis is a difficult condition to treat. Treatment is limited to alleviation of pain and other symptoms. Surgical intervention generally has a poor outcome and only provides temporary relief. Steroid injection is generally discouraged and may worsen the condition.
Medical Therapy
Surgery
Prevention
Future or Investigational Therapies
Recent research has indicated that a group of chemicals called cytokines that are produced by various cells in the body may be responsible for generating the pain response. Medications that affect the release of cytokines or block the action of cytokines may reduce the pain response. Various anti-cytokine medications are now being used to treat painful disease states such as Rheumatoid Arthritis and Crohn's Disease. In a recent study the anti-cytokine medication, Thalidomide, is being evaluated for its effect in treating pain associated with Arachnoiditis.
External links
- Circle Of Friends With Arachnoiditis (COFWA)
- American Chronic Pain Association (ACPA)
- National Chronic Pain Outreach Association (NCPOA)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
- National Institute of Dental and Craniofacial Research (NIDCR)
- Arachnoiditis
- Arachnoiditis, if you have ever suffered from back pain or know anyone who has then this is where to find help and information.
- Support for those with disorders of the Arachnoid Membrane
- http://www.burtonreport.com/InfSpine/AdhesArachAnatomy.htm
References
- ↑ Elkington, J. St. C. (1951). Arachnoiditis. In Modern Trends in Neurology, ed. Anthony Feiling, ch. 5, pp. 149-161. Butterworths, London.
- ↑ ELKINGTON, J. St. C. (1936). Meningitis serosa circumscripta spinalis (spinal arachnoiditis). Brain, 59, 181-203
- ↑ Foix C, Alajouanine T . La myélite nécrotique subaigue. Rev Neurol (Paris) 1926; 2: 1–42.