Arachnoiditis associated with arachnoid cyst formation and cord tethering following myelography: Magnetic resonance features

Abstract

The reported incidence of clinically significant arachnoiditis following oil-based contrast media myelography is approximately 1%. The incidence of arachnoiditis in the dorsal spine is even more rare. Acquired arachnoid cyst formation can occur with arachnoiditis of various aetiologies. A case is presented of a patient with chronic backache, radiculopathy, weakness and muscle wasting, who had undergone myelography with oil-based contrast media about 28 years ago. There was no history of spinal surgery, spinal canal stenosis, disc disease or trauma, all of which are known to increase the risk of arachnoiditis. Magnetic resonance imaging features are presented in this case of arachnoiditis with arachnoid cyst formation, and cord tethering.

Pantopaque contrast mimicking intracanalicular vestibular schwannoma

“…We hypothesize that our patient's symptoms were due to an aseptic meningitis or posterior cranial fossa arachnoiditis spawned by the presence of Pantopaque droplets, a known complication of long‐standing retained contrast material within the subarachnoid space . Previous cases reporting the histopathological findings of resected Pantopaque have shown evidence of fibrosis, inflammation, vasculitis, and calcifications, sometimes decades after administration, further supporting the inflammatory potential these lesions can create .…”

“…Pantopaque (Iophenydylate, Lafayette Pharmacal; Lafayette, Louisiana) is an oil‐based contrast medium that was widely used for myelograms during the 1940s through 1980s . However, residual contrast media was found to reside in the subarachnoid space due to its extremely low clearance rate, thereby potentially leading to chronic irritation, arachnoid adhesions, severe arachnoiditis, or nerve root irritation . In addition, its presence may mimic other pathologies, such as benign intracranial or spinal tumors, providing a source of diagnostic confusion when evaluating these patients .…”

“…1 However, residual contrast media was found to reside in the subarachnoid space due to its extremely low clearance rate, thereby potentially leading to chronic irritation, arachnoid adhesions, severe arachnoiditis, or nerve root irritation. [2][3][4] In addition, its presence may mimic other pathologies, such as benign intracranial or spinal tumors, providing a source of diagnostic confusion when evaluating these patients. [5][6][7] Pantopaque was replaced by water-soluble contrast agents and therefore has no longer been used in the United States since the late 1980s.…”

Thoracolumbar meningeal fibrosis in pugs

“…The spinal cord lesions from the pugs with thoracolumbar myelopathy in this study shared many features with the spinal cord of laboratory dogs, used in research about adhesive, also called constrictive, arachnoiditis . Adhesive arachnoiditis, a rare chronic myelopathy in people, is characterized by meningeal fibrosis that has been described to cause disruption of the vascular supply and the development of arachnoid diverticula, syringomyelia and myelomalacia . Familiar adhesive arachnoiditis, with a suggested genetic influence, has been described .…”

“…39,40 Adhesive arachnoiditis, a rare chronic myelopathy in people, is characterized by meningeal fibrosis that has been described to cause disruption of the vascular supply and the development of arachnoid diverticula, syringomyelia and myelomalacia. [41][42][43][44][45][46] Familiar adhesive arachnoiditis, with a suggested genetic influence, has been described. [47][48][49] In process dysplasias, are difficult to document without CT. 3 Although a previous study, including pugs of similar age as in the present study, could not confirm an association between CVMs and neurological signs, it has been suggested that some CVMs in pugs are indeed clinically significant.…”