OBJECTIVE: Chronic adhesive arachnoiditis (CAA) is rare and has potentially devastating clinical consequences. The objective of this article is to review the clinical features of CAA and describe its appearance on imaging, to increase radiologists' awareness of this challenging diagnosis. MATERIALS AND METHODS: Twenty-nine cases of advanced CAA seen at our institution over 18 years (1995-2013) were retrospectively reviewed. Chart review was performed, with attention given to data on clinical presentation, suspected cause, and interventions performed. All patients underwent MRI, and seven patients also underwent CT myelography. Clinical and imaging features were evaluated and categorized. RESULTS: The 29 patients ranged in age from 23 to 96 years and included 11 women and 18 men. Suspected underlying causative factors included trauma (n = 10), prior surgery (n = 9), nontraumatic subarachnoid hemorrhage (n = 7), infection (n = 3), myelography with iophendylate used as contrast medium (n = 1), Guillain-Barré syndrome (n = 1), ankylosing spondylitis (n = 1), and unknown causes (n = 1). Imaging characteristics include loculated CSF collections (n = 23), nerve root clumping, enhancement, and displacement (n = 15), cord swelling with increased T2 signal (n = 12), arachnoid septations (n = 11), cord atrophy (n = 6), syrinx (n = 5), and intrathecal calcifications (n = 3). Ten patients underwent surgical procedures, and most had only brief clinical improvement. CONCLUSION: CAA is a rare cause of devastating neurologic symptoms and chronic pain. The imaging features of CAA range from subtle to severe. Advanced arachnoiditis can present with spinal cord swelling and syrinx formation, which can mimic other disease processes. Inclusion of advanced CAA in the differential diagnosis can prevent unnecessary interventions.
OBJECTIVE:Chronic adhesive arachnoiditis (CAA) is rare and has potentially devastating clinical consequences. The objective of this article is to review the clinical features of CAA and describe its appearance on imaging, to increase radiologists' awareness of this challenging diagnosis. MATERIALS AND METHODS: Twenty-nine cases of advanced CAA seen at our institution over 18 years (1995-2013) were retrospectively reviewed. Chart review was performed, with attention given to data on clinical presentation, suspected cause, and interventions performed. All patients underwent MRI, and seven patients also underwent CT myelography. Clinical and imaging features were evaluated and categorized. RESULTS: The 29 patients ranged in age from 23 to 96 years and included 11 women and 18 men. Suspected underlying causative factors included trauma (n = 10), prior surgery (n = 9), nontraumatic subarachnoid hemorrhage (n = 7), infection (n = 3), myelography with iophendylate used as contrast medium (n = 1), Guillain-Barré syndrome (n = 1), ankylosing spondylitis (n = 1), and unknown causes (n = 1). Imaging characteristics include loculated CSF collections (n = 23), nerve root clumping, enhancement, and displacement (n = 15), cord swelling with increased T2 signal (n = 12), arachnoid septations (n = 11), cord atrophy (n = 6), syrinx (n = 5), and intrathecal calcifications (n = 3). Ten patients underwent surgical procedures, and most had only brief clinical improvement. CONCLUSION:CAA is a rare cause of devastating neurologic symptoms and chronic pain. The imaging features of CAA range from subtle to severe. Advanced arachnoiditis can present with spinal cord swelling and syrinx formation, which can mimic other disease processes. Inclusion of advanced CAA in the differential diagnosis can prevent unnecessary interventions.
Authors: Carol S Palackdkharry; Stephanie Wottrich; Erin Dienes; Mohamad Bydon; Michael P Steinmetz; Vincent C Traynelis Journal: PLoS One Date: 2022-09-30 Impact factor: 3.752
Authors: Panagiotis Mastorakos; I Jonathan Pomeraniec; Jean-Paul Bryant; Prashant Chittiboina; John D Heiss Journal: J Neurosurg Spine Date: 2021-10-01
Authors: Chankue Park; In Sook Lee; Kyoung Hyup Nam; You Seon Song; Tae Hong Lee; In Ho Han; Dong Hwan Kim Journal: Korean J Radiol Date: 2020-08-28 Impact factor: 3.500