A Clinical Lecture ON CHRONIC SPINAL MENINGITIS: ITS DIFFERENTIAL DIAGNOSIS AND SURGICAL TREATMENT

Abstract

Without wearying you with details, I may say that I have seen a relatively large number of such cases, on most of which I have performed laminectomy and subdural mercurial irrigation. All the cases also which have been referred to me have been diagnosed at the time I have received them as tumour of the spinal cord or disease of the vertebral column. But naturally during ten years one becomes more wary, and I have for a long time shown that there are certain features in these cases which should lead to their being recognized as cases of chronic spinal meningitis and not tumour. That is the position which now deserves discussion. I would have raised this question long ago but for the fact that inasmuch as the first twenty operations were not followed by death, no anatomical examination of the condition was forthcoming.In 2 cases, however, we have obtained the spinal cord.In one the operation had been completed, and six weeks after the wound healed the patient died suddenly from syphilitic myositis-probably of the atrioventricular bundle.In the other no oper4ion was done, and the patient succumbed to the paraplegia. In both a meningo-gliosis (sclerosis) was found. The spinal cord, so often seen at the operations to be shrunken, was markedly contracted in a tabes case, and exhibited microscopically typical glial sclerosis.

Modern Ideas About Epidural Fibrosis (Literature Review)

“…В 1909 г. британский хирург Виктор Хорсли [32] и многие другие авторы описали спинальный арахноидит различными терминами, в том числе: хронический спинальный арахноидит, адгезивный спинальный арахноидит, хронический спинальный менингит, спинальный менингит с радикуломиелопа-тией, поясничный адгезивный арахноидит, спиналь-ный арахноидит, спинальный фиброз и пояснично-крестцовый арахноидит. Кроме того, на основании конкретных рентгенологических или патологических данных его называли кальцинированным арахноиди-том или пахименингитом [32].…”

“…Кроме того, на основании конкретных рентгенологических или патологических данных его называли кальцинированным арахноиди-том или пахименингитом [32]. Для того чтобы понять термины «адгезивный арахноидит» и «эпидуральный фиброз», а также причины и патогенез данных про-цессов, необходимо знать анатомо-функциональные особенности структурных элементов позвоночного канала (пространства, оболочки, сосудов) и цирку-ляции ликвора [48].…”

“…При полном инкапсулировании нервных корешков возникает их гипоксия и прогрес-сирующая атрофия. Адгезия, или слипание корешков, происходит преимущественно на дорзальных сегмен-тах [32]. Точный временной ход этих трёх фаз не вы-яснен.…”

Non-traumatic adhesive arachnoiditis as a cause of spinal cord syndromes. Investigation on 507 patients

“…Horsley (1909) suggested that not only syphilis but also gonorrhoea were responsible for his 'Chronic Spinal Meningitis' patients. In fact, all the authors from Asia and Africa dealing with the problem do accept syphilis as a cause of the meningovascular changes, luetic meningitis and arach noiditis.…”

“…Several earlier authorities from the numerous papers on the issue should be mentioned here (Charcot & Joffroy, 1869;Joffroy, 1873; Horsley, 1909;Elkington, 1936). Arachnoiditis after tuberculous meningitis was described by Brouwer (1931), Ransome and Montiero (1947), Arseni and Samitca (1960), Bawa and Wahi (1961), Jenkins (1963), Parsons and Pallis (1965), Wadia and Dastur (1969), Dastur and Wadia (1969), Tandon and Pathak (1973), Wadia (1973), Freilich and Swash (1979) and others.…”