Arachnoiditis

Changed by Bruno Di Muzio, 9 May 2016

Back to revision history

Updates to Article Attributes

Body was changed:

Show markup changes

Arachnoiditis is a broad term encompassing inflammation of the meninges~~and~~ and subarachnoid space.

Terminology

Arachnoiditis affecting the cauda equina may be referred to as spinal/lumbar adhesive arachnoiditis.

Clinical presentation

Lumbar spine arachnoiditis can result in leg pain, sensory changes and motor weakness.

In some individuals, CSF flow is impaired, and they may develop syringomyelia which should, therefore, be sought in the cord.

Pathology

Aetiology

infectious
- meningitis
inflammatory
- surgery
- intrathecal haemorrhage
- intrathecal compounds
  - lipiodol-containing contrast media, e.g. iophendylate ~~(Pantopaque~~(Pantopaque^TM/Myodil^TM) ~~(controversial~~- controversial ³)
  - anesthetics
  - steroids (accidental intrathecal injection)

Leptomeningeal carcinomatosis can also lead to nerve root clumping, although this is not strictly speaking inflammatory in nature. Nonetheless, it is sometimes included under the broader meaning of arachnoiditis, and certainly can mimic ~~runofthemill~~run-of-the-mill arachnoiditis.

haematogenous spread of systemic tumours
direct seeding of the CSF from primary central nervous system tumours

Radiographic features

All modalities will demonstrate similar findings, although MRI is by far the most sensitive modality. Although arachnoiditis can be present throughout the subarachnoid space, it is most easily seen in the lumbar region where the cauda equina usually floats in ample CSF. In arachnoiditis the nerve roots are irregularly thickened and clumped together, often stuck to the dura, resulting in an empty thecal sac sign.

Rarely ossification / dystrophic calcification occurs and this is known as arachnoiditis ossificans.

Treatment and prognosis

No treatment is available for adhesive arachnoiditis.

-<p><strong>Arachnoiditis </strong>is a broad term encompassing inflammation of the <a href="/articles/meninges">meninges </a>and subarachnoid space.</p><h4>Terminology</h4><p>Arachnoiditis affecting the cauda equina may be referred to as <strong>spinal/lumbar adhesive arachnoiditis</strong>. </p><h4>Clinical presentation</h4><p>Lumbar spine arachnoiditis can result in leg pain, sensory changes and motor weakness.</p><p>In some individuals CSF flow is impaired, and they may develop <a href="/articles/syringomyelia">syringomyelia</a> which should therefore be sought in the cord.</p><h4>Pathology</h4><h5>Aetiology</h5><ul>
+<p><strong>Arachnoiditis </strong>is a broad term encompassing inflammation of the <a href="/articles/meninges">meninges</a> and subarachnoid space.</p><h4>Terminology</h4><p>Arachnoiditis affecting the cauda equina may be referred to as <strong>spinal/lumbar adhesive arachnoiditis</strong>. </p><h4>Clinical presentation</h4><p>Lumbar spine arachnoiditis can result in leg pain, sensory changes and motor weakness.</p><p>In some individuals, CSF flow is impaired, and they may develop <a href="/articles/syringomyelia">syringomyelia</a> which should, therefore, be sought in the cord.</p><h4>Pathology</h4><h5>Aetiology</h5><ul>
~~-<li>lipiodol-containing contrast media, e.g. iophendylate (Pantopaque<sup>TM</sup>/Myodil<sup>TM</sup>) (controversial <sup>3</sup>)</li>~~
+<li>lipiodol-containing contrast media, e.g. iophendylate (<a title="Pantopaque" href="/articles/pantopaque">Pantopaque<sup>TM</sup></a>/Myodil<sup>TM</sup>) - controversial <sup>3</sup>
+</li>
-</ul><p><a title="Leptomeningeal carcinomatosis" href="/articles/leptomeningeal-metastases">Leptomeningeal carcinomatosis</a> can also lead to nerve root clumping, although this is not strictly speaking inflammatory in nature. Nonetheless it is sometimes included under the broader meaning of arachnoiditis, and certainly can mimic runofthemill arachnoiditis. </p><ul>
+</ul><p><a href="/articles/leptomeningeal-metastases">Leptomeningeal carcinomatosis</a> can also lead to nerve root clumping although this is not strictly speaking inflammatory in nature. Nonetheless, it is sometimes included under the broader meaning of arachnoiditis and certainly can mimic run-of-the-mill arachnoiditis. </p><ul>
-</ul><h4>Radiographic features</h4><p>All modalities will demonstrate similar findings, although MRI is by far the most sensitive modality. Although arachnoiditis can be present throughout the <a href="/articles/spinal-subarachnoid-space">subarachnoid space</a>, it is most easily seen in the lumbar region where the <a href="/articles/cauda-equina">cauda equina</a> usually floats in ample CSF. In arachnoiditis the nerve roots are irregularly thickened and clumped together, often stuck to the dura, resulting in an <a href="/articles/empty-thecal-sac-sign">empty thecal sac sign</a>. </p><p>Rarely ossification / dystrophic calcification occurs and this is known as <a href="/articles/arachnoiditis-ossificans">arachnoiditis ossificans</a>. </p><h4>Treatment and prognosis</h4><p>No treatment is available for adhesive arachnoiditis. </p><h5> </h5>
+</ul><h4>Radiographic features</h4><p>All modalities will demonstrate similar findings although MRI is by far the most sensitive modality. Although arachnoiditis can be present throughout the <a href="/articles/spinal-subarachnoid-space">subarachnoid space</a>, it is most easily seen in the lumbar region where the <a href="/articles/cauda-equina">cauda equina</a> usually floats in ample CSF. In arachnoiditis the nerve roots are irregularly thickened and clumped together, often stuck to the dura, resulting in an <a href="/articles/empty-thecal-sac-sign">empty thecal sac sign</a>. </p><p>Rarely ossification / dystrophic calcification occurs and this is known as <a href="/articles/arachnoiditis-ossificans">arachnoiditis ossificans</a>. </p><h4>Treatment and prognosis</h4><p>No treatment is available for adhesive arachnoiditis. </p><h5> </h5>

ADVERTISEMENT: Supporters see fewer/no ads

{"current_user":null,"inclusions":[{"imageId":1114431,"studyId":13892,"caseSlug":"arachnoiditis","caption":"Case 1: with empty theca sign","thumbnail":"https://prod-images-static.radiopaedia.org/images/1114431/a0b773c781329c9d4ca03e58a61e45_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":5244026,"studyId":26336,"caseSlug":"postoperative-adhesive-arachnoiditis","caption":"Case 2: post operative","thumbnail":"https://prod-images-static.radiopaedia.org/images/5244026/b55fcdee46955b73261a3daaa95f27_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":10244551,"studyId":34383,"caseSlug":"arachnoiditis-1","caption":"Case 3","thumbnail":"https://prod-images-static.radiopaedia.org/images/10244551/9d9f201db6dffb1f24a73080265c37_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":2140509,"studyId":18531,"caseSlug":"tuberculous-arachnoiditis","caption":"Case 4: tuberculous arachnoiditis","thumbnail":"https://prod-images-static.radiopaedia.org/images/2140509/cdadf1d2ddb4234cf120d900bbb229_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"possible"},{"imageId":5066679,"studyId":25987,"caseSlug":"adhesive-arachnoiditis-empty-thecal-sac-sign","caption":"Case 5: with empty thecal sac sign","thumbnail":"https://prod-images-static.radiopaedia.org/images/5066679/1b233143743e97a5f72865f7ffe47c_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":54262922,"studyId":101841,"caseSlug":"tuberculous-arachnoiditis-1","caption":"Case 6: tuberculous arachnoiditis","thumbnail":"https://prod-images-static.radiopaedia.org/images/54262922/IMG-0003-00017_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"}],"ddx_inclusions":[{"imageId":1159635,"studyId":13943,"caseSlug":"postoperative-lumbar-nerve-root-enhancement","caption":"Postoperative lumbar nerve root enhancement","thumbnail":"https://prod-images-static.radiopaedia.org/images/1159635/e794e7ed60c6d6f0044639dd076822_big_gallery.jpg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"}],"lang":"us"}