Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
Sign up to receive an email alert when a new Case of the Week is posted.
June 10, 2013
Focal Adhesive Arachnoiditis
- Focal adhesive arachnoiditis is the end stage of arachnoiditis, where progressive inflammatory process involving the arachnoid leads to scarring
- Clinical features: Lower back or lower limb pain is a common presentation. Other symptoms include lower limbs weakness and bladder, bowel, and sexual dysfunction
- Causes: Infection, intrathecal steroids or anaesthetics, intrathecal haemorrhage, trauma or prior surgery. Arachnoiditis complicates 6-16% of spinal surgeries.
- It can lead to progressive syringomyelia or myelomalacia due to a tethering effect on the spinal cord, with consequent altered CSF dynamics.
- Key Diagnostics Features: Conventional and CT myelogram features include sleeveless appearance of the roots, filling defects, narrowing, shortening, and occlusion of the thecal sac. As disease progresses, the nerve roots adhere to one another and the dura, leading to appearance of empty sac, and later, clumping becomes more prominent until the thecal sac and roots are one soft tissue mass. Similar changes are seen on MR with central clumping and empty sac.
- Rx: Symptomatic treatment, including pain management, muscle relaxants, and physiotherapy. Microsurgical arachnoidolysis.