Arachnoiditis ossificans with arachnoid cyst after cranial tuberculous meningitis

Paesschen, Wim Van; Kerchove, M. van den; Appel, Bernard; Klaes, R.; Neetens, I.; Lowenthal, A

doi:10.1212/wnl.40.4.714

Cited by 25 publications

(14 citation statements)

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“…However, arachnoiditis ossificans (AO) is a unique and uncommon phenomenon characterized by intrathecal bony metaplasia of the arachnoid membrane 1. This pathology develops following numerous predisposing processes including surgery, trauma, infection, myelography and subarachnoid hemorrhage 2,3,4. As of yet, the pathophysiology of AO is unknown; however, it may be a result of chronic inflammation of the arachnoid 5…”

Section: Introductionmentioning

confidence: 99%

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Arachnoiditis ossificans associated with syringomyelia: An unusual cause of myelopathy

Ibrahim

Kamali-Nejad²,

Fehlings³

2010

Evidence-Based Spine-Care Journal

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Objective: The pathophysiology of arachnoiditis ossificans (AO) and its association with syringomyelia remains a rare and poorly understood phenomenon. Here, we present a case of AO associated with syringomyelia, a review of literature, and a discussion of current understanding of disease pathophysiology.Methods: A literature review was performed using MEDLINE (January 1900–May 2010) and Embase (January 1900–May 2010) to identify all English-language studies that described AO with syringomyelia. The current report was added to published cases.Results: Over 50 cases of AO are reported in literature, of which only eight are associated with syringomyelia. The various presumptive etiologies of syrinx formation include abnormalities in blood circulation, ischemia, hydrodynamic alternations in cerebrospinal fluid (CSF) flow, tissue damage, or incidental coexistence. Changing CSF dynamics related to decreased compliance of the subarachnoid space and subsequent paracentral dissection of the spinal cord may be implicated in the disease process. magnetic resonance imaging (MRI) scanning may identify the syrinx but fail to diagnose the calcified arachnoid. Five patients, including the current case, improved clinically following laminectomy and decompression.Conclusions: Syringomyelia in association in AO is a rare phenomenon. A high index of suspicion is required and both MRI and computed tomography (CT) are recommended for diagnosis. The pathophysiology of syringomyelia in AO remains an area of ongoing research.

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Section: Introductionmentioning

confidence: 99%

“…Over 50 reports of AO are documented in literature; however, only eight of these are associated with syringomyelia 2,3,4,5,6,7,8,9. The pathophysiology of syrinx development in this disease state is controversial.…”

Section: Introductionmentioning

confidence: 99%

Arachnoiditis ossificans associated with syringomyelia: An unusual cause of myelopathy

Ibrahim

Kamali-Nejad²,

Fehlings³

2010

Evidence-Based Spine-Care Journal

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“…Van et al . 24 in 1990 reported one case of acquired spinal cord arachnoid cyst after tuberculous meningitis. Lolge et al 25 in 2004 also reported two such cases; the cyst in one was located at the anterior part of the foramen magnum.…”

Section: Discussionmentioning

confidence: 99%

Foramen Magnum Arachnoid Cyst Induces Compression of the Spinal Cord and Syringomyelia: Case Report and Literature Review

Huang¹,

Li²,

Xu³

et al. 2011

Int. J. Med. Sci.

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It is very rare that a foramen magnum arachnoid cyst induces compression of the spinal cord and syringomyelia, and currently there are few treatment experiences available. Here we reported the case of a 43-year-old male patient who admitted to the hospital due to weakness and numbness of all 4 limbs, with difficulty in urination and bowel movement. MRI revealed a foramen magnum arachnoid cyst with associated syringomyelia. Posterior fossa decompression and arachnoid cyst excision were performed. Decompression was fully undertaken during surgery; however, only the posterior wall of the arachnoid cyst was excised, because it was almost impossible to remove the whole arachnoid cyst due to toughness of the cyst and tight adhesion to the spinal cord. Three months after the surgery, MRI showed a reduction in the size of the arachnoid cyst but syrinx still remained. Despite this, the symptoms of the patient were obviously improved compared to before surgery. Thus, for the treatment of foramen magnum arachnoid cyst with compression of the spinal cord and syringomyelia, if the arachnoid cyst could not be completely excised, excision should be performed as much as possible with complete decompression of the posterior fossa, which could result in a satisfying outcome.

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“…Inflammatory cells such as lymphocytes or neutrophils are usually absent, 15,18,27,29 except in one reported case of AO secondary to tuberculous meningitis 28 and in another case, that was found soon after the patient uderwent myelography. Inflammatory cells such as lymphocytes or neutrophils are usually absent, 15,18,27,29 except in one reported case of AO secondary to tuberculous meningitis 28 and in another case, that was found soon after the patient uderwent myelography.…”

Section: Histological Featuresmentioning

confidence: 97%

“…Magnetic resonance imaging is quite useful for diagnosis of associated features such as arachnoidal cyst, 1,21,28 intramedullary cavitation, 10,16,21 and meningocele. 1 Gadolinium enhancement of fibrous scars surrounding the nerve roots is indicative of the extension of arachnoiditis, 23 suggesting an occurrence prior to the ossification that acts as a matrix for the osseous process.…”

Section: Radiological Featuresmentioning

confidence: 99%

Arachnoiditis ossificans of the cauda equina

Faure

Khalfallah²,

Perrouin-Verbe³

et al. 2002

Journal of Neurosurgery: Spine

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✓ The authors describe a case of arachnoiditis ossificans (AO) of the cauda equina. The lesion is a rare pathological entity usually confined to the thoracic and high lumbar regions that can cause progressive spinal cord and cauda equina compression, inducing severe neurological deterioration. The authors analyze the clinical symptoms, radiological features, histological data, and treatment options relating to this case and 13 others described in the literature; additionally, they consider the possible mechanisms responsible for ossification of the leptomeninges. Although clustered arachnoidal cells are usually implicated in its pathogenesis, an environment induced by arachnoiditis and disturbed cerebrospinal fluid flow appears to be a more important factor. A therapeutic strategy is proposed for AO for which no effective treatment currently exists.

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Arachnoiditis ossificans with arachnoid cyst after cranial tuberculous meningitis

Cited by 25 publications

References 0 publications

Arachnoiditis ossificans associated with syringomyelia: An unusual cause of myelopathy

Arachnoiditis ossificans associated with syringomyelia: An unusual cause of myelopathy

Foramen Magnum Arachnoid Cyst Induces Compression of the Spinal Cord and Syringomyelia: Case Report and Literature Review

Arachnoiditis ossificans of the cauda equina

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