Arachnoiditis
Arachnoiditis is a severe inflammatory disease of the arachnoid membrane of the brain or spinal cord. The symptoms of pathology depend on its spread in the brain and localization. Arachnoiditis must be differentiated from asthenia, with which it has similar symptoms. Treatment of the disease involves complex conservative (drug) therapy. In the presence of serious complications, the patient is assigned the first, second or third disability group.
The content of the article:
Causes of arachnoiditis
Pathogenesis of arachnoiditis
Classification of arachnoiditis
Symptoms of arachnoiditis
General cerebral symptoms of arachnoiditis
Focal symptoms of arachnoiditis
Diagnosis of arachnoiditis
Treatment of arachnoiditis
Prognosis for arachnoiditis
Arachnoiditis
Causes of arachnoiditis
In most patients with arachnoiditis, infectious diseases are a predisposing factor. In particular, these diseases include chickenpox, influenza, measles, viral meningitis, cytomegalovirus infection, meningoencephalitis. Chronic intoxication of the body, inflammatory diseases of the paranasal sinuses, and injuries can also provoke the disease. Arachnoiditis is often diagnosed in patients who have reactive inflammation of a growing tumor.
Pathology can also occur due to acute or chronic purulent otitis media. In this case, the inflammation is provoked by toxins and low-virulent microbes. Researchers also attribute various complications of purulent otitis media (petrositis, labyrinthitis, synustrombosis), brain abscess, purulent meningitis and otogenic encephalitis to the causes of the disease.
In neurology, there are also a number of factors that are considered predisposing to the occurrence of the disease. Such factors include intoxication (for example, alcohol), frequent viral diseases, chronic fatigue, hard work in an unfavorable climate, frequent injuries. In 10% of all cases of the disease, it is impossible to establish the exact etiology.
Pathogenesis of arachnoiditis
To understand the nature of the disease, it is necessary to familiarize yourself with the anatomical features of the brain. The arachnoid membrane, which is affected by inflammation in arachnoiditis, is located between the soft and dura mater. At the same time, it is not spliced with them, but simply fits snugly. Unlike the soft meninges, the arachnoid membrane does not penetrate into the cerebral gyrus. Small spaces filled with cerebrospinal fluid are formed under it.
All these spaces connect to the fourth ventricle. Through these spaces there is an outflow of cerebrospinal fluid from the cranial cavity. The mechanism of arachnoiditis is as follows: due to the effects of various causes and provoking factors, the production of antibodies to the spider web is activated in the body, which then provokes its inflammation. In patients with arachnoiditis, there is turbidity and noticeable thickening of the arachnoid membrane, as well as the appearance of cystic extensions and connective tissue adhesions in it.
Classification of arachnoiditis
Arachnoiditis of the cerebral membranes
This type of disease is also called cerebral. Cerebral arachnoiditis is localized in the posterior cranial fossa, on the convex surface of the brain and its base. The clinical picture of this disease is characterized by regular headaches, impaired circulation of cerebrospinal fluid. In the most severe cases, the disease is accompanied by convulsive seizures, which can even lead to an epileptic status.
Arachnoiditis of the brain is often located in the central gyri and anterior parts of the large hemisphere. Due to the resulting pressure on the sensory and motor centers, the patient may experience disorders of sensitivity and movement. In the case of compression of the cerebral cortex or the formation of a cyst in it due to arachnoiditis, the patient may have epileptic seizures.
Opto-chiasmal arachnoiditis
This type of arachnoiditis is localized mainly in the chiasmal region. Common causes of this form of arachnoiditis are angina, malaria, syphilis, infectious diseases of the paranasal sinuses, traumatic brain injuries. This type of arachnoiditis is characterized by the formation of adhesions in the area of the intracranial part of the optic nerves and chiasm. In the most difficult cases, a scarring may form around the chiasm.
As a rule, the disease provokes the patient’s vision problems. At the same time, the degree of decrease in the patient’s vision can vary from its minimal decrease to blindness. In most cases of optic-chiasmal arachnoiditis, optic nerve atrophy occurs in patients. Visual symptoms are often very pronounced, while hypertension symptoms are moderate.
Arachnoiditis of the posterior cranial fossa
It is the most common type of cerebral arachnoiditis. The severity of the symptoms of the disease depends on the localization and nature of the inflammatory process, as well as its combination with hydrocephalus. The formation of cysts and adhesions usually leads to the closure of the ventricular openings of the brain, which provokes an increase in intracranial pressure. If the intracranial pressure does not increase and is normal, the disease can last for a long time.
The acute form of pathology is characterized by all the symptoms of high intracranial pressure: nausea, dizziness, vomiting, bradycardia, severe headache localized in the occipital region. With a less acute course of the disease, the signs of damage to the posterior cranial fossa become the most pronounced. Patients may also experience symptoms such as unsteadiness of gait and spontaneous nystagmus.
Arachnoiditis of the spinal cord membranes
This is a spinal form of arachnoiditis, which occurs mainly due to purulent abscesses and furunculosis. The symptoms of the disease are similar to the signs of an extramedullary tumor: patients have motor and sensory disorders, as well as radicular syndrome (restriction of mobility, paraesthesia, trophic changes, pain in the heart, lower back and stomach, neck and extremities).
Spinal arachnoiditis is localized mainly at the level of the lumbar and thoracic segments, as well as on the posterior surface of the spinal cord. Usually arachnoiditis of the membranes of the spinal cord is chronic.
Symptoms of arachnoiditis
The first symptoms of the disease appear a long time after exposure to the provoking factor on the body, which caused its appearance. During this time, autoimmune processes occur in the patient’s body.
The duration of this interval is directly related to which factor affected the body. For example, after a patient has had the flu, the first symptoms of arachnoiditis appear after a long period of time — from three to twelve months. After a traumatic brain injury, this interval is reduced to 1-2 hours. At first, the patient is concerned about the symptoms characteristic of asthenia: sleep disturbance, weakness, fatigue, irritability. However, over time, more serious focal and cerebral symptoms of arachnoiditis may appear.
General cerebral symptoms of arachnoiditis
The cerebral complex of symptoms of arachnoiditis of the brain is characterized by cerebrospinal fluid-hypertension syndrome. Most patients complain of a sharp headache, which is most active in the morning and may worsen due to coughing, physical exertion and straining. The consequences of increased intracranial pressure are disorders such as painful sensations when moving the eyes, vomiting, nausea, a feeling of strong pressure on the eyes.
Many patients turn to a neurologist with complaints such as hearing loss, tinnitus, dizziness attacks. Therefore, during the diagnosis, the doctor should exclude various ear diseases such as labyrinthitis, chronic otitis, cochlear neuritis, adhesive otitis. It is also possible that symptoms characteristic of vegetative-vascular dystonia may appear.
Patients with arachnoiditis occasionally have cerebrospinal fluid crises — headaches accompanied by vomiting, nausea and dizziness. Rare crises are attacks with a frequency of no more than 1-2 per month, average — 3-4 times, frequent — more than 4 times. Depending on the severity of the symptoms during the crisis, its mild, medium and severe forms are distinguished. The latter can last about two days.
Focal symptoms of arachnoiditis
Focal signs of the disease occur depending on its localization. Convexital arachnoiditis is characterized by impaired sensitivity and motility of the limbs of mild and moderate severity. More than 35% of patients with this form of arachnoiditis have epileptic seizures. At the end of the attack, the patient has a neurological deficit for some time.
Basilar arachnoiditis, which is localized in the optic chiasmal region, occurs with serious attention and memory disorders, as well as a decrease in mental abilities. In addition, patients with this form of pathology complain of a significant decrease in visual acuity and other disorders. In rare cases, optic chiasmal arachnoiditis is accompanied by inflammation of the pituitary gland, which provokes an endocrine exchange syndrome, the symptoms of which are similar to the signs of pituitary adenoma.
Arachnoiditis of the posterior cranial fossa is characterized by a very severe course. As a rule, patients show signs of facial neuritis and trigeminal neuralgia. Focal manifestations of arachnoiditis also include various cerebellar disorders: cerebellar ataxia, impaired coordination, nystagmus.
Diagnosis of arachnoiditis
Diagnosis of arachnoiditis involves a comprehensive assessment by a neurologist of the features of the course of the disease and its clinical signs. One of the important stages of diagnosis is the collection of anamnesis, during which the neurologist pays attention to the nature and development of neurological symptoms, recent traumatic brain injuries of the patient and the infections he has suffered. A study of the neurological status is also being conducted, which makes it possible to detect mnestic and psycho-emotional disorders, as well as neurological deficits.
Since arachnoiditis is characterized by visual and auditory disorders, a neurologist may need to consult an ophthalmologist and an otolaryngologist for differential diagnosis. The otolaryngologist checks the degree and type of hearing loss using the threshold audiometry technique. It is possible to determine the degree of damage to the auditory analyzer by studying auditory evoked potentials, electrocochleography and acoustic impedance measurement.
Instrumental techniques such as skull radiography, electroencephalography and echo-encephalography are not considered sufficiently effective in the diagnosis of arachnoiditis, since they provide limited information about the presence of the disease in the patient. However, with their help, you can detect some symptoms of pathology. For example, X-ray of the skull detects symptoms of prolonged intracranial hypertension, echo-encephalography detects hydrocephalus, and electroencephalography can detect epileptic activity.
More information about the disease can be collected using MRI and CT scans of the brain. Both of these studies are used to identify morphological changes in the brain (atrophic changes, the presence of adhesions and cysts) and the nature of hydrocephalus. These techniques are also used to exclude tumors, hematomas and abscesses of the brain. The doctor receives accurate information about intracranial pressure by performing a lumbar puncture.
Treatment of arachnoiditis
The main purpose of medical treatment of arachnoiditis is to eliminate the source of infection with antibiotics. Antihistamine and desensitizing medications (diazoline, histaglobulin, diphenhydramine, suprastin, pipolfen, tavegil, calcium chloride) are indicated. Drug therapy also provides for the improvement of metabolism and local blood circulation, as well as normalization of intracranial pressure.
Patients who have an increase in intracranial pressure are indicated to take diuretics and decongestants (furosemide, mannitol, glycerin, diacarb). Antiepileptic medications (carbamazepine, finlepsin, keppra) are used to eliminate convulsive syndrome. According to the indications , the doctor may prescribe drugs from the following drug groups:
absorbable (rumalon, lidazu, pyrogenal);
antiallergic (loratadine, tavegil, diazolin);
neuroprotectors and metabolites (mildronate, nootropil, ginkgo biloba);
psychotropic drugs (tranquilizers, antidepressants, sedatives).
Surgical intervention
If the drug treatment did not give the desired results, the patient has occlusive hydrocephalus or progressive vision loss, the doctor decides on surgical intervention. During the operation, the adhesions are disconnected and the cysts are removed. To reduce the manifestations of hydrocephalus, bypass operations are prescribed.
The prognosis for the patient is often favorable. Only arachnoiditis of the posterior cranial fossa, which is almost always accompanied by occlusive hydrocephalus, can pose a great danger. With frequent relapses of the disease, epileptic seizures and its opto-chiasmal form, the labor prognosis for the patient may worsen.
Prognosis for arachnoiditis
In most cases, patients with arachnoiditis receive a third disability group. However, if they have severe visual impairment and epileptic seizures often occur, they may be assigned a second disability group. The first disability group includes patients with opto-chiasmal arachnoiditis, which provoked complete blindness. Patients with arachnoiditis are contraindicated to work on transport, at altitude, near a fire, in noisy rooms, in unfavorable climatic conditions, with toxic substances.
