Arachnoiditis: What consequences? (How to treat?)

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Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

THEarachnoiditis designates theinflammation of the arachnoid. Each year, it affects approximately 25 people. According to the frequency of spinal procedures, arachnoid is more common in Asia, Europe, North and South America. Let's take a closer look at what this condition is in this article (causes, symptoms, treatment, etc.).

Definition and anatomy

THEarachnoid is one of the envelopes of the brain and the spinal cord. More precisely, three meninges protect and cover the central nervous system.

  • Outside there is the dura mater, Also called pachymeninge ou hard meninge, which is responsible for protecting the brain. Located in the cavity of the skull, the latter is made up of the cerebellum, the cerebrum and the brainstem (above the spinal cord). Lining the cranium, the hard meninge separates the bone from these different nerve structures.
  • In the middle there is thearachnoid, this is the intermediate membrane. It is thin and soft, and contains no blood vessels.
  • Inside there is the pia mater which directly envelops the nervous tissue. Unlike the two previous membranes, this one is very thin and vascularized.

Between the pia mater and the arachnoid is the subarachnoid space in which is contained the cerebrospinal or cerebrospinal fluid (LCS or CSF). It is in this fluid that the brain and spinal cord are bathed, and it is this fluid which circulates in the spinal canal.

So thearachnoiditis indicates the disorder caused by theinflammation of this intermediate membrane. This disorder can also result from the presence of a lesion in the area inside the arachnoid.

What causes arachnoiditis?

The there are many causes of arachnoiditis. It can be either of mechanical origin or of chemical origin. It can be localized or diffuse.

In the majority of cases, this disorder results from a spinal surgery or an neuro-axial anesthesia. But it also happens that it happens:

  • following a lumbar puncture ;
  • after one myelography : it is an examination of the spinal cord which requires an injection of contrast products. However, since the abundance of oily contrast products, this radiography leads to fewer and fewer cases of arachnoiditis;
  • in case of repetition ofsubarachnoid injections anti-metabolites or anti-cancer drugs;
  • in the presence ofbacterial and viral infections full spine ;
  • when foreign bodies penetrate inside the second meninge after an intervention;
  • in case of'subarachnoid hemorrhage (meningeal hemorrhage) of the spinal cord: it is a blood irruption in the space located below the arachnoid;
  • in a patient undergoing treatment withinfiltrations of corticosteroids and anesthetics.

What are the symptoms of arachnoiditis?

Depending on the location and extent of the inflammation, the symptoms of arachnoiditis may vary from patient to patient. They can be:

  • headache ;
  • epileptic seizures;
  • irritation of the spinal cord with the appearance of motor disorders such as paraplegia or tetraplegia;
  • genito-sphincter disorders such as urinary incontinence, delayed urination, permanent feeling of a full bladder, etc.
  • sensory disturbances such as loss of thermal sensitivity or numbness. They mark the achievement of the nerve roots of the spinal cord.

When the arachnoid affects the brain and spinal cord at the same time, the disease can manifest as a hydrocephalus communicating. However, this case remains rare.

What are the consequences of arachnoiditis?

A arachnoiditis can be complicated and result in:

  • a syringomyelia (development of a cavity inside the spinal cord);
  • un cauda equina syndrome (compression or damage to the nerve roots of the caudal [lower] end of the spinal cord);
  • of pseudo-meningoceles (abnormal collection of cerebrospinal fluid);
  • of intraspinal cysts.

The consequences ofinflammation of the second brain can also impact tissue elasticity. Indeed, these can lose their elasticity. We are talking about fibrosis. This condition can lead to adhesion of the marrow with the nerve roots and produce:

  • low back pain;
  • pain in the legs associated with sensory motor disorders;
  • disturbance of reflexes.

 

According to the course of inflammation, two phases of arachnoiditis are distinguished :

  • la early stage during which the nerve roots are edematous;
  • la late proliferative phase, or adhesive arachnoiditis, during which the roots are organized asymmetrically. This phase is followed by a disturbance in the flow of cerebrospinal fluid between the brain and the dural bag as well as an increase in intrathecal pressure. This increase will lead to postural headaches and back pain. In rare cases, the scar tissue can become calcified: it is an ossifying arachnoid.

How to make the diagnosis of arachnoiditis?

Le arachnoid diagnosis is mainly based on the anamnesis through which the doctor collects different information about the manifestation of the disease and the medical history of the patient.

To determine the origin of the disorder, the diagnosis is completed by an MRI performed with an injection of contrast product. This imaging test will highlight arachnoiditis, and indicate nerve root changes. Moreover, we see that the latter are organized towards the center and are attached to the dura mater on the periphery. Also, we see in this area the presence of a partitioning of the cerebrospinal fluid in the thecal sac.

Since MRI cannot take place, the myeloscanner is an alternative solution. It makes it possible to see the adhesions which affect the dorsal segments and agglutinate in the periphery.

If necessary, differential diagnoses may be necessary. A differential diagnosis must be made in particular in the event of:

  • disc sequestration (intraspinal hematoma);
  • painful syndrome of multiple spine operations;
  • immediate postoperative occurrence.

Treatment: how to treat arachnoiditis?

Just like the symptoms, the treatment varies depending on the patient's situation. the treatment of arachnoiditis is above all symptomatic and consists of acting on the cause. If the disorder is of infectious origin, the treatment is based on the administration of antibiotics.

In the early phase, treatment consists of administering high doses of intravenous methylprednisolone during 5 days. This treatment is most effective when applied within three months of the causative event. In combination, the patient also takes other medications such as anti-inflammatories, antiepileptics and antidepressants. With regard to opiates, it is not appropriate to take them in high doses. This exposes you to the risk ofhyperalgesia, hypersensitivity, dependence and tachyphylaxis.

If necessary, lidocaine, MgSO4 or ketamine can be prescribed for intense pain.

Le arachnoid treatment becomes more complicated when it enters the late proliferative phase. The disease tends to become chronic. Instead of treating it, injections, interventions or various invasive procedures in the spine can make it worse.

In addition to medication, surgery may be an option. It can be a rhizotomy (cauterization of the nerve roots) or a ganglionectomy (removal of nerve ganglia). However, even if it manages to relieve pain, the result is only felt in the short term. This is also the case with epidural corticosteroid injections and the removal of nerve root adhesions.

Sources

https://www.vulgaris-medical.com/encyclopedie-medicale/arachnoide/symptomes

https://www.orpha.net/consor/cgi-bin/OC_Exp.php?Expert=137817&lng=FR

https://www.apaiser.org/les-pathologies-proches/

https://www.sciencedirect.com/science/article/abs/pii/S116983300400290X

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