Spinal Toxoplasmic Arachnoiditis Associated With Osteoid Formation

Te, Cosan; Kabukçuoğlu, Sare; Arslantaş, Ali; Ma, Atasoy; Doğan, Nihal; Özgüneş, İlhan; Kebabci, M; E, Tel

doi:10.1097/00007632-200108010-00019

Cited by 18 publications

(10 citation statements)

References 18 publications

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“…The diseases or medications that impair the immunologic defense mechanisms, such as AIDS, Hodgkin disease, immunosuppressive therapy are commonly the major culprits. Isolated spinal toxoplasmic arachnoiditis was also reported [28]. Toxoplasmic myelitis should be suspected in immunocompromised patients with an intramedullary lesion.…”

Section: Parasitic Infectionsmentioning

confidence: 90%

Spinal infections

Tali

G�ltekin

2004

Eur Radiol

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Spinal infections have an increasing prevalence among the general population. Definitive diagnosis based solely on clinical grounds is usually not possible and radiological imaging is used in almost all patients. The primary aim of the authors is to present an overview of spinal infections located in epidural, intradural and intramedullary compartments and to provide diagnostic clues regarding different imaging modalities, particularly MRI, to the practicing physicians and radiologists.

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Section: Parasitic Infectionsmentioning

confidence: 90%

Spinal infections

Tali

G�ltekin

2004

Eur Radiol

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“…Many patients with neurological disease are unaware of their HIV status. Furthermore, toxoplasmic myelopathy has been described in patients without HIV, albeit with severe immunosuppression [2, 3, 11, 12], and in patients with isolated spinal cord lesions [1, 2, 11]. New neurological deficit in any patient should raise a high index of suspicion of HIV infection.…”

Section: Discussionmentioning

confidence: 99%

“…The initial evaluation should aid in differentiating between other reported causes of myelopathy (such as vacuolar myelopathy, lymphoma, tuberculosis, and viral infections including cytomegalovirus infection, herpes zoster, and herpes simplex) in AIDS patients [2, 4]. Since 1986, 18 cases of apparent toxoplasmosis of the spinal cord have been described [4, 7, 11, 12]. A case report and pertinent literature were reviewed, leading to the diagnosis and management options discussed below.…”

Section: Introductionmentioning

confidence: 99%

Spinal cord toxoplasmosis as an unusual presentation of AIDS: case report and review of the literature

et al. 2010

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Approximately 10% of patients with AIDS present with some neurological deficit as their initial complaint, and up to 80% will have CNS involvement during the course of their disease. Toxoplasmosis is the most common cause of cerebral mass lesions in patients with AIDS, but appears to be an uncommon cause of spinal cord disease. The incidence of myelopathy may be as high as 20%, with 50% of the cases reported post-mortem. We present a unique case of spinal cord disease as the initial presentation of AIDS. We also present a comprehensive literature review of this topic, its diagnosis and treatment. This is a retrospective chart review case report. After a detailed case presentation, several diagnostic and therapeutic aspects of this unique case are thoroughly discussed. Although spinal cord toxoplasmosis is uncommon, it has been suggested that most patients with AIDS that present with evolving myelopathy, characterized by extremity weakness, sensory involvement, spinal cord enlargement, enhancing lesions in brain or spinal cord CT or MRI, have toxoplasmic myelitis.

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“…2 Tethering of the spinal cord and arachnoid cyst formation have been associated with previous trauma. 1,16,18,34,37 Arachnoiditis has been found to occur as a result of infection (for example, tuberculosis and malarial infections of the meninges), 9,10,20,24,27 and after cranial aneurysmal subarachnoid hemorrhage, with blood settling in the spinal subarachnoid space and causing delayed arachnoiditis. 3,13,23,39 Ionic intrathecal contrast administration is another known cause of thoracic and lumbar arachnoiditis.…”

Section: Discussionmentioning

confidence: 99%

Surgical manifestations of thoracic arachnoid pathology: series of 28 cases

Griessenauer¹,

Bauer²,

Moore

et al. 2014

SPI

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Object Various pathologies involving the thoracic arachnoid mater uniformly manifest as thoracic myelopathy and may present a significant management dilemma. The authors undertook this study to assess outcome in cases of thoracic myelopathy due to thoracic arachnoid pathology. Methods The authors have cared for and followed 28 patients with thoracic myelopathy from thoracic arachnoid pathology over the last 17 years. A chart review and contemporary follow-up of these patients was performed and outcomes were reported. Results Patients with thoracic myelopathy from thoracic arachnoid pathology often have improvement in their condition after surgical decompression/detethering procedures. While not universal, patients in this series had improvement in mJOA scores at 1 year after surgery (p = 0.0001) and at last follow-up (p = 0.04). Results indicated that across a wide variety of pathologies the extent of thoracic spinal cord involvement is a predictor of the disease course and outcome. Comparison of the group of patients with cord involvement limited to 2 vertebral segments (short-segment pathology) versus the group with cord tethering of more than 2 segments (long-segment pathology) showed that patients in the short-segment group more frequently had ventral or dorsal arachnoid bands (p = 0.003), more frequently had signal change in the cord on MRI (p = 0.02), and less frequently presented with a syrinx (p = 0.02), and a smaller percentage of patients in this group underwent reoperation (p = 0.02). While patients with short-segment pathology typically improved after a single operative intervention, patients with long-segment pathology typically improved after multiple operations, frequently for CSF diversion. Conclusions Thoracic arachnoid pathology causing thoracic cord dysfunction and myelopathy is varied, has multiple etiologies, and can be difficult to treat over the long term. Surgical management, when indicated, is case specific. Serial long-term follow-up is essential to document enduring clinical and radiographic success.

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Spinal Toxoplasmic Arachnoiditis Associated With Osteoid Formation

Abstract: Where no causative factor is found in serious spinal adhesive arachnoiditis, the possibility of spinal toxoplasmosis should also be investigated.

Cited by 18 publications

References 18 publications

Spinal infections

Spinal infections

Spinal cord toxoplasmosis as an unusual presentation of AIDS: case report and review of the literature

Surgical manifestations of thoracic arachnoid pathology: series of 28 cases

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