Arachnoiditis
Introduction
Introduction to arachnoiditis Arachnoiditis refers to a tissue reaction of the arachnoid membrane of the brain or spinal cord under the influence of certain etiologies, characterized by arachnoid thickening, adhesion and cyst formation. In essence, this is a pathological diagnosis, not a disease unit, more common in young and middle-aged. May be manifested as an acute, subacute or chronic course. The patient has varying degrees of fever and systemic symptoms. Because the main site of brain arachnoiditis is the posterior cranial fossa, optic chiasm and cerebral hemisphere convex surface. basic knowledge Sickness ratio: 0.0001% Susceptible people: blue, middle-aged Mode of infection: non-infectious Complications: hydrocephalus
Cause
Cause of arachnoiditis
Infection (40%):
1. Central nervous system infection: can be secondary to various types of meningitis, encephalomyelitis, especially viral infections caused by serous meningitis. 2. Infections outside the central nervous system: Systemic infections such as colds, flu, rheumatism, pneumonia, tuberculosis, sepsis, pelvic infections, etc., may be the cause of the disease.
Trauma (20%):
Both craniocerebral trauma and spinal trauma can occur, the trauma can be very mild, and the cranial muscles or spine can be changed without fractures.
Foreign body enters the subarachnoid space (15%):
Such as subarachnoid hemorrhage, antibiotics, anesthetics, contrast agents and so on.
The central nervous system has primary lesions (10%):
Such as tumors, syringomyelia, optic neuritis, multiple sclerosis.
Skull and spinal lesions (3%):
Such as skull base depression, spinal bone hyperplasia, disc herniation, spinal stenosis and so on.
Poisoning (3%):
Such as lead poisoning, alcoholism and so on.
Other (3%):
It may be caused by non-suppurative meningitis with insignificant clinical signs or unidentified causes, especially viral infections.
Prevention
Arachnoiditis prevention
Control intracranial and extracranial infections, actively prevent and treat various brain injury, and reduce intrathecal injection of drugs, all help to prevent brain arachnoiditis.
Complication
Arachnoiditis complications Complications hydrocephalus
Because adhesions and endometrial membranes are also inflammatory and thickened and occluded, it can cause ischemia and necrosis of adjacent nerve parenchyma; cysts can compress nerve tissue to produce secondary degeneration, such as adhesions affecting cerebrospinal fluid circulation, such as blockage of the fourth ventricle The middle hole and the side hole can cause water accumulation in the brain.
Symptom
Symptoms of arachnoid inflammation Common symptoms: papilledema edema, ataxia, arachnoid thickening, visual acuity, deafness, tinnitus, nystagmus, tremor, spinal cord compression
Because the location of the disease is different, the clinical symptoms are different. Common ones are:
(a) brain arachnoiditis .
1. Posterior cranial fossa arachnoiditis:
(1) dorsal type: clinical symptoms are mainly increased intracranial pressure, headache, vomiting, papilledema, etc., and can cause neck and neck pain due to chronic occipital foramen magnum, neck stiffness.
(2) ventral type: dizziness, nystagmus, deafness of the lesion side, tinnitus, peripheral facial paralysis, facial sensation diminished, corneal reflex disappearance and limb ataxia.
2. Cerebral hemisphere convex arachnoiditis: The main symptoms are headache and seizures. The headache can be localized or diffuse. It is generally mild, sometimes it can be aggravated when the head position changes. Epilepsy is mostly limited, localized nerves. Symptoms such as hemiplegia, aphasia, etc. are less severe.
3. Optic arachnoiditis: mainly headache and visual impairment.
(2) Spinal arachnoiditis : It is more common in the thoracic cord and cervical spinal cord disease. It is often followed by post-root irritation, which causes root pain in the area affected by nerve roots. It varies in severity and can be relieved after rest, often lasting for several months. Different degrees of spinal cord compression symptoms appear several years later.
(C) cerebrospinal arachnoiditis : for the brain and spinal cord have lesions, both can occur at the same time, or from the spinal cord lesions to the posterior cranial concave skull base, resulting in the corresponding spinal cord and cranial nerve damage symptoms.
Examine
Arachnoiditis examination
diagnosis
Cobweb encephalitis often has different causes, different causes, clinical manifestations, and atypical, simple diagnosis based on clinical manifestations, relying on auxiliary examination to confirm the diagnosis, but also has its characteristics, which is helpful for diagnosis.
1. Patients often have primary causes of arachnoiditis such as intracranial, extracranial infection, craniocerebral injury and surgery, subarachnoid hemorrhage.
2. The onset may be acute or subacute, gradually becoming chronic, or chronically at the beginning, with a long course of disease, repeated and relieved, and may be induced by colds, infections, fatigue, and the like.
3. The focal symptoms are mild or multifocal, and can also be diffuse, so the symptoms are variable.
Laboratory inspection
In the early stage of lumbar puncture, the pressure can be normal. In most patients, the pressure of cerebrospinal fluid is slightly elevated, and the pressure of those with hydrocephalus is significantly increased. In the acute phase, the number of cerebrospinal fluid cells increased slightly (50×106 /L or less), mainly lymphocytes, and the chronic phase was normal. Protein quantification can be slightly increased.
Other auxiliary inspection
1. Skull X-ray film can show signs of chronic intracranial hypertension or normal.
2. CT scan can show local cystic low-density changes, ventricular system shrinkage, normal or consistent expansion. Other intracranial space-occupying lesions can be excluded by scanning.
3. MRI scan showed clearer than the CT on the skull base and posterior cranial fossa. And can exclude other intracranial space-occupying lesions.
Diagnosis
Diagnosis and diagnosis of arachnoiditis
diagnosis
Cobweb encephalitis often has different causes, different causes, clinical manifestations, and atypical, simple diagnosis based on clinical manifestations, relying on auxiliary examination to confirm the diagnosis, but also has its characteristics, which is helpful for diagnosis.
1. Patients often have primary causes of arachnoiditis such as intracranial, extracranial infection, craniocerebral injury and surgery, subarachnoid hemorrhage.
2. The onset may be acute or subacute, gradually becoming chronic, or chronically at the beginning, with a long course of disease, repeated and relieved, and may be induced by colds, infections, fatigue, and the like.
3. The focal symptoms are mild or multifocal, and can also be diffuse, so the symptoms are variable.
Differential diagnosis
1. The posterior cranial fossa midline arachnoiditis must be differentiated from the tumor in this area. The posterior cranial fossa midline tumors include cerebellar sac tumors and fourth ventricle tumors. Children are more common and often malignant medulloblastoma. Symptoms develop rapidly. The condition is serious, and there may be signs of brain stem compression and bilateral pyramidal tract signs.
2. Arachnoiditis of the cerebellopontine angle and the tumors in this area. The tumors in this area are mostly acoustic neuromas, in addition to meningiomas and epidermoid cysts. Such as acoustic neuroma and meningioma, early symptoms of auditory nerve damage, followed by facial nerve, trigeminal nerve and cerebellar damage symptoms. Symptoms of trigeminal neuralgia often occur in early epidermoid cysts. Skull X-ray film, acoustic neuroma can occur in the internal auditory canal destruction and expansion, meningioma can have rock bone destruction and calcification. A CT or MRI scan can determine the diagnosis.
3. Arachnoiditis at the intersection of the gods and the tumors in this area. The most common tumors in this area are pituitary adenomas and craniopharyngioma. Most of the pituitary adenomas have endocrine disorders in the early stage, and the changes in the fundus and visual field are typical. The craniopharyngioma is more common in children, and the X-ray plain saddle may have calcification. There are still saddle nodule meningioma in this area, which is characterized by vision loss and visual field disorder of optic nerve chronic compression, and primary optic atrophy occurs later. These lesions can be displayed by CT and MRI scans, and their lesions can be identified and clearly diagnosed.
4. Cerebral hemispherical convex arachnoiditis and cerebral hemisphere superficial glioma, hemangioma, metastasis and tuberculosis and other lesions. Most of these lesions can be diagnosed by CT or MRI scan.
