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Spinal arachnoid web (AW) is a rare condition causing spinal cord-related issues. Its cause is often idiopathic but can be linked to past trauma or spine surgery. We describe two cases of AWs that developed after subarachnoid hemorrhage (SAH). Case #1 is a 71-year-old male with nonaneurysmal SAH who developed myelopathy 1 year later. Magnetic resonance imaging revealed upper thoracic cord edema and an AW. Case #2 is a 57-year-old female who underwent coiling of a ruptured basilar artery aneurysm and ventriculoperitoneal shunting for hydrocephalus. Twenty months later, she developed mid-thoracic AW requiring surgical resection. Both patients showed symptom improvement postresection avoiding further reoperation. History of SAH is emerging as a risk factor for AW development, emphasizing the importance of monitoring delayed-onset myelopathy and back pain in recent SAH patients.

Spinal arachnoid web (AW) is a rare condition causing spinal cord-related issues. Its cause is often idiopathic but can be linked to past trauma or spine surgery. We describe two cases of AWs that developed after subarachnoid hemorrhage (SAH). Case #1 is a 71-year-old male with nonaneurysmal SAH who developed myelopathy 1 year later. Magnetic resonance imaging revealed upper thoracic cord edema and an AW. Case #2 is a 57-year-old female who underwent coiling of a ruptured basilar artery aneurysm and ventriculoperitoneal shunting for hydrocephalus. Twenty months later, she developed mid-thoracic AW requiring surgical resection. Both patients showed symptom improvement postresection avoiding further reoperation. History of SAH is emerging as a risk factor for AW development, emphasizing the importance of monitoring delayed-onset myelopathy and back pain in recent SAH patients. [ABSTRACT FROM AUTHOR]

Yeng F Her,1 Ryan T McWilliams,2 Erik A Ovrom,3 James C Watson1 1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA; 2Family Medicine, Alaska Native Medical Center, Anchorage, AK, USA; 3Mayo Clinic Alix School of Medicine, Mayo Clinic Hospital, Rochester, MN, USACorrespondence: Yeng F Her, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA, Email her.yeng@mayo.eduAbstract: Arachnoiditis is difficult to treat. Patients are often left frustrated after many failed trials of conservative therapies without symptom resolution. Surgery may provide symptom relief for a short period of time, but their pain often returned. Herein, we present three cases of acute arachnoiditis following three different pain procedures: epidural blood patch, IDDS implant, and epidural steroid injection. The patients were diagnosed and treated with corticosteroids within 10 days of the procedure. Two patients were treated with the same oral steroid regiment, while the third patient was treated with both oral and IV steroid. All three patients had good outcomes at the completion of their steroid therapy. This case series may provide insight into treating acute and subacute arachnoiditis from pain interventions.Keywords: arachnoiditis, epidural blood patch, intrathecal pain pump, epidural steroid injection, corticosteroid therapy

A series of 5 patients treated with the fourth ventricle to spinal subarachnoid space stent (FVSSS) is presented. Indication for surgery, surgical technique, pre-operative and post-operative images, and outcome are analyzed. A systematic review of the pertinent literature has also been performed. This is a retrospective cohort review of a series of 5 consecutive patients with refractory syringomyelia who underwent a fourth ventricle to spinal subarachnoid space shunt surgery. The surgical indication was based on the presence of refractory syringomyelia in patients already treated for Chiari malformation or in patients who developed scarring at the level of the outlets of the fourth ventricle following posterior fossa tumor surgery. The mean age at FVSSS was 11.30 ± 5.88 years. Cerebral MRI revealed crowded posterior fossa, with a membrane at the level of the foramen of Magendie. Spinal MRI showed syringomyelia in all patients. Before surgery, the averages of the craniocaudal and the anteroposterior diameter were 22.66 and 1.01 cm, respectively, whereas the volume was 28.16 cm3. The post-operative period was uneventful in 4 out of 5 patients; one child died on the 1st post-operative day due to complications unrelated to surgery. In remaining cases, syrinx marked improvement. The post-operative volume was 1.47 cm3 with an overall reduction of 97.61%. With regard to literature, 7 articles with a total of 43 patients were analyzed. After FVSSS, syringomyelia reduction was observed in 86.04% of cases. Three patients underwent reoperation due to syrinx recurrence. Four patients presented a catheter displacement, one a wound infection and meningitis and one CSF leak requiring placement of a lumbar drain. FVSSS is highly effective in restoring CSF dynamics, with dramatic improvement of syringomyelia. In all our cases, the volume of the syrinx was reduced by at least 90%, with improvement/resolution of accompanying symptomatology. This procedure should be reserved to patients in which other causes of gradient pressure between the fourth ventricle and subarachnoid space are excluded, for example, tetraventricular hydrocephalus. Surgical procedure is not simple, because it requires meticulous microdissection of cerebello-medullary fissure and upper cervical spine, in already operated patients. To avoid migration of the stent, it should be carefully sutured to the dura mater or thick arachnoid membrane. [ABSTRACT FROM AUTHOR]

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Secondary spinal arachnoid cysts have rarely been reported but present significant challenges for management. These cysts could be anteriorly located with long rostral–caudal extensions and many are related to arachnoiditis, leading to difficult-to-treat disorders. Thus far, due to the scarcity of reports, the features of the disease and the optimal therapeutic strategies remain unclear. To investigate clinical features and the optimal treatment modalities of secondary spinal arachnoid cysts compared with primary spinal arachnoid cysts. Systematic review. Systematic review identified 103 secondary cases from 80 studies and reports. Condition of symptom relief and duration of treatment response were analyzed. An electronic literature search of the PubMed database was conducted for studies on secondary spinal arachnoid cysts between 1990 and 2022. Non-English publications, nonhuman studies, reports of a primary cyst, studies not including case details, and studies of nonsymptomatic cases were excluded. This systematic review included 103 secondary cases. The most commonly reported etiologies were iatrogenic factors, trauma, and subarachnoid hemorrhage, accounting for 88 intradural extramedullary, 11 extradural, one intradural/extradural, one interdural, and one intramedullary spinal arachnoid cyst after a median duration of 30, 12, and 9 months, respectively. Extradural cysts were more prone to occur at dorsal locations and affect thoracic segments (mean cyst length: 3.4 segments). Intradural cysts showed a relatively higher ventral/dorsal ratio (1:1.09, 1.75:1, and 3.50:1 for cysts occurring from iatrogenic factors, trauma, and subarachnoid hemorrhage, respectively) and thoracic distribution, with a mean cyst length of 4.3 segments (5.1 for ventral and 3.5 for dorsal cysts). For intradural cysts, recurrence risk was lower after surgical resection than after fenestration/marsupialization (12-month recurrence risk: 21.43% vs 50.72%, log-rank test: p=.0248, Gehan–Breslow–Wilcoxon test: p=.0126). In cases treated with shunting, one recurrence (1/8 cases) was noted after external shunting and two recurrences (2/5 cases) after internal shunting at a median follow up of 12 months. Secondary spinal arachnoid cysts, particularly intradural cysts, are rarer and more challenging to treat than primary spinal cysts. Although fenestration/marsupialization is the commonly adopted treatment, the recurrence rate is high. For unresectable cysts, shunting procedures, particularly shunting into a body cavity (eg, pleural or peritoneal cavity) away from the subarachnoid space, could be a therapeutic alternative besides fenestration/marupialization, yet its efficacy requires confirmation by more data. [ABSTRACT FROM AUTHOR]

Tuberculosis involving the spinal cord is associated with high mortality and disabling long-term sequelae. Although tuberculous radiculomyelitis is the most frequent complication, pleomorphic clinical manifestations exist. Diagnosis can be challenging among patients with isolated spinal cord tuberculosis due to diverse clinical and radiological presentations. The principles of management of tuberculosis of the spinal cord are primarily derived from, and dependent upon, trials on tuberculous meningitis (TBM). Although facilitating mycobacterial killing and controlling host inflammatory response within the nervous system remain the primary objectives, several unique features require attention. The paradoxical worsening is more frequent, often with devastating outcomes. The role of anti-inflammatory agents such as steroids in adhesive tuberculous radiculomyelitis remains unclear. Surgical interventions may benefit a small proportion of patients with spinal cord tuberculosis. Currently, the evidence base in the management of spinal cord tuberculosis is limited to uncontrolled small-scale data. Despite the gargantuan burden of tuberculosis, particularly in lower and middle-income countries, large-scale cohesive data are surprisingly sparse. In this review, we highlight the varied clinical and radiological presentations, performance of various diagnostic modalities, summarize data on the efficacy of treatment options, and propose a way forward to improve outcomes in these patients.

Chiari I malformation has been defined as cerebellar tonsillar descent greater than 5 mm below the foramen magnum. Suboccipital decompression remains the mainstay of treatment for symptomatic patients. Other conditions sometimes have imaging features that mimic Chiari I malformation. These patients are at risk of misdiagnosis and mismanagement, including surgery that may be unnecessary or may even worsen the underlying condition. The aim of this study was to analyse a series of Chiari I malformation mimics and identify differentiating imaging features. The mimics are categorised as post-traumatic cranio-cervical junction arachnoiditis, dural band, spontaneous intracranial hypotension, idiopathic intracranial hypertension, and cysts. Better understanding of these conditions will assist with diagnosis and optimal management, including avoiding unnecessary surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Tubercular infection of the brain and spine is relatively common in endemic regions of the world. Central nervous system tuberculosis can have varied manifestations. The familiar imaging findings are hydrocephalus, ring-enhancing tuberculomas, and meningeal enhancement, having a preference for basal regions. Myelitis is the most common imaging manifestation of spine, with holocord involvement being a rare presentation, as seen in our case. Case presentation We present a case of a pediatric patient undergoing treatment for a tubercular infection of the brain. The patient developed acute onset quadriparesis, manifesting as holocord transverse myelitis on imaging. The imaging findings in the brain manifested as basal meningeal enhancement and non-communicating hydrocephalus, managed by shunt placement. As of the latest, the patient is on follow-up and has a stable disease course. Clinical and laboratory investigations excluded other infectious and non-infectious causes of transverse myelitis, including neuromyelitis optica spectrum disorders. Conclusions Longitudinally extensive transverse myelitis is a rare complication of tubercular myelitis seen as a long-segment signal abnormality with swelling of the cord and corresponding post-contrast enhancement. Involvement of the entire cord is rare, with a handful of cases reported in the literature.

Tuberculosis involving the spinal cord is associated with high mortality and disabling long-term sequelae. Although tuberculous radiculomyelitis is the most frequent complication, pleomorphic clinical manifestations exist. Diagnosis can be challenging among patients with isolated spinal cord tuberculosis due to diverse clinical and radiological presentations. The principles of management of tuberculosis of the spinal cord are primarily derived from, and dependent upon, trials on tuberculous meningitis (TBM). Although facilitating mycobacterial killing and controlling host inflammatory response within the nervous system remain the primary objectives, several unique features require attention. The paradoxical worsening is more frequent, often with devastating outcomes. The role of anti-inflammatory agents such as steroids in adhesive tuberculous radiculomyelitis remains unclear. Surgical interventions may benefit a small proportion of patients with spinal cord tuberculosis. Currently, the evidence base in the management of spinal cord tuberculosis is limited to uncontrolled small-scale data. Despite the gargantuan burden of tuberculosis, particularly in lower and middle-income countries, large-scale cohesive data are surprisingly sparse. In this review, we highlight the varied clinical and radiological presentations, performance of various diagnostic modalities, summarize data on the efficacy of treatment options, and propose a way forward to improve outcomes in these patients. [ABSTRACT FROM AUTHOR]

The central nervous system is lined by meninges, classically known as dura, arachnoid, and pia mater. We show the existence of a fourth meningeal layer that compartmentalizes the subarachnoid space in the mouse and human brain, designated the subarachnoid lymphatic-like membrane (SLYM). SLYM is morpho- and immunophenotypically similar to the mesothelial membrane lining of peripheral organs and body cavities, and it encases blood vessels and harbors immune cells. Functionally, the close apposition of SLYM with the endothelial lining of the meningeal venous sinus permits direct exchange of small solutes between cerebrospinal fluid and venous blood, thus representing the mouse equivalent of the arachnoid granulations. The functional characterization of SLYM provides fundamental insights into brain immune barriers and fluid transport. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: Arachnoiditis ossificans (AO) in the spine is a rare entity characterized by progressive calcification of the arachnoid and dural sac, with consequent neurological involvement. Objective: Review the causes, clinical manifestations, and complementary studies for their correct diagnosis. Method: Systematic review under PRISMA guidelines, with search in Pubmed, Lilacs, and Embase. Patient demographics (sex and age), history reported as a cause of AO and time elapsed between cause and diagnosis of AO, clinical manifestations, and complementary studies used for diagnosis were collected. Results: 38 articles, of which we collected 46 patients (25 women, 21 men), mean age of 52 years. The most frequent cause was previous spine surgery and myelography with fat-soluble contrast. The most frequent symptoms were insufficient muscle strength (74%) and pain (69%). CT was used in 76%. The most frequent location was thoracic (35%). Conclusion: Its pathogenesis is unclear; described as the final cause of a chronic inflammatory process in the arachnoid with the consequent bone metaplasia. Diagnosis usually precedes a long period of pain and progressive neurological symptoms. The most sensitive and specific complementary study for the diagnosis is the tomography without contrast, which should be requested in case of clinical suspicion. Level of Evidence II; Systematic Review.

Background: Tubercular infection of the brain and spine is relatively common in endemic regions of the world. Central nervous system tuberculosis can have varied manifestations. The familiar imaging findings are hydrocephalus, ring-enhancing tuberculomas, and meningeal enhancement, having a preference for basal regions. Myelitis is the most common imaging manifestation of spine, with holocord involvement being a rare presentation, as seen in our case. Case presentation: We present a case of a pediatric patient undergoing treatment for a tubercular infection of the brain. The patient developed acute onset quadriparesis, manifesting as holocord transverse myelitis on imaging. The imaging findings in the brain manifested as basal meningeal enhancement and non-communicating hydrocephalus, managed by shunt placement. As of the latest, the patient is on follow-up and has a stable disease course. Clinical and laboratory investigations excluded other infectious and non-infectious causes of transverse myelitis, including neuromyelitis optica spectrum disorders. Conclusions: Longitudinally extensive transverse myelitis is a rare complication of tubercular myelitis seen as a long-segment signal abnormality with swelling of the cord and corresponding post-contrast enhancement. Involvement of the entire cord is rare, with a handful of cases reported in the literature. [ABSTRACT FROM AUTHOR]

Arachnoiditis is a rare clinical entity that usually presents with severe debilitating radiating pain that can pose a challenge in diagnosis especially in areas without appropriate imaging modalities. We present a 26-year-old male with progressive lower back pain with radiation to the lower extremities, aggravated by movement and touch. We diagnosed idiopathic arachnoiditis based on cerebrospinal fluid analysis and magnetic resonance imaging. He was managed with a 5-day course of methylprednisolone and analgesics with a good outcome. Severe back pain without a specific cause in a young patient should be investigated with proper imaging modalities and lumbar puncture if warranted to evaluate the cause.

Chiari I malformation has been defined as cerebellar tonsillar descent greater than 5 mm below the foramen magnum. Suboccipital decompression remains the mainstay of treatment for symptomatic patients. Other conditions sometimes have imaging features that mimic Chiari I malformation. These patients are at risk of misdiagnosis and mismanagement, including surgery that may be unnecessary or may even worsen the underlying condition. The aim of this study was to analyse a series of Chiari I malformation mimics and identify differentiating imaging features. The mimics are categorised as post-traumatic cranio-cervical junction arachnoiditis, dural band, spontaneous intracranial hypotension, idiopathic intracranial hypertension, and cysts. Better understanding of these conditions will assist with diagnosis and optimal management, including avoiding unnecessary surgery.

Objectives: The aim of this study was to determine the occurrence of dural puncture, indicated by cerebrospinal fluid (CSF) outflow, in cats receiving neuraxial anesthesia through a lumbosacral injection guided by a pop sensation method. Methods: This was an observational, retrospective study. Cats that were scheduled for lumbosacral neuraxial anesthesia were included. Medical records were analyzed to investigate: (1) demographic data; (2) neuraxial anesthesia performed (epidural/spinal); (3) type of needle used, including gauge and length; (4) presence of CSF (yes/no) and/or blood (yes/no) in the hub of the needle; and (5) flicking of the tail during needle advancement (yes/no). Results: A total of 94 medical records were analyzed. A 22 G 50 mm Tuohy needle was used in all cats scheduled for an epidural injection (n = 60), whereas a 22 G 40 mm Quincke needle was used in all cats scheduled for an intrathecal injection (n = 34). CSF outflow was detected in 55/60 (91.7%) cats in which a Tuohy needle was used, and 34/34 (100%) of the cats in which a Quincke needle was used (P = 0.15). Flicking of the tail was detected in 41/60 (68.3%) and in 24/34 (70.6%) injections with Tuohy and Quincke needles, respectively (P >0.99). Traces of blood, but not active blood outflow, were detected via staining of the first drops of CSF in 2/34 cats in which Quincke needles were used and in none of the cats in which Tuohy needles were used (P = 0.12). Conclusions and relevance: This study shows that the lumbosacral approach for neuraxial anesthesia in cats may result in a dural sac puncture when 22 G Quincke or Tuohy needles are used. The pop sensation method should be deemed effective in predicting intrathecal but not epidural needle placement. [ABSTRACT FROM AUTHOR]

Background: Arachnoiditis refers to chronic inflammation of the arachnoid mater and subarachnoid space due to three major etiologies: chemical, mechanical, and postinfectious. As a rare disease with variable symptomatology and severity at presentation, arachnoiditis can be extremely debilitating with many complications, prominent among which is syringomyelia. Methods: We reviewed current literature concerning postinfectious spinal arachnoiditis and associated syringomyelia with emphasis on the treatment options that have been used to date and discuss their respective benefits and drawbacks. Results: It is critical to understand the natural history and potential complications of patient with postinfectious arachnoiditis. Surgical and medical treatments both have their own merits and demerits. Different surgical approaches have been employed with variable success rates. Conclusion: At present, no consensus exists regarding management of these patients due to the variable nature of the disease that affects treatment efficacy; however, surgical intervention in selected cases may be beneficial. [ABSTRACT FROM AUTHOR]

Background: Coccidioidomycosis meningitis (CM) is the most aggressive form of coccidioidomycosis, requiring lifelong antifungal treatment and often cerebrospinal fluid (CSF) diversion. Long-standing CM can be associated with spinal complications such as arachnoiditis. However, studies describing the frequency, clinical, and imaging characteristics of arachnoiditis in patients with CM are limited. Methods: We identified 133 patients with CM based on CSF culture, PCR, or serology between January 2010 and December 2020. Of these, 37 patients underwent spinal imaging. Data on demographics, risk factors, symptoms, antifungal therapy, surgical management, follow-up visits, adherence, serological trends, and imaging findings were reviewed. Results: Abnormal findings were observed in 30 of the 37 patients with CM who underwent spinal imaging. The imaging abnormalities noted in our study included leptomeningeal enhancement (53%), arachnoiditis (53%), syringomyelia (23%), cord signal abnormalities (10%), and osteomyelitis (7%). Of the 30 patients, 90% had symptoms, such as weakness, numbness, or urinary retention. The incidence of arachnoiditis in the present study was 12%. Higher initial CSF protein levels and intra cranial pressure were associated with a higher risk of developing arachnoiditis/syringomyelia. Management of CM was challenging, as evidenced by shunt failure (46%), medication non-compliance (57%), and lack of adequate follow-up (60%). Persistent disabilities were noted in 62% of the patients. Conclusions: Patients with CM develop spinal complications such as arachnoiditis, or syringomyelia. Many cases may go undetected due to lack of symptoms in early stages. CM management challenges such as shunt failure, lack of follow-up care, and medication noncompliance, were frequent.

Background: Prior imaging studies characterizing lumbar arachnoiditis have been based on small sample numbers and have reported inconsistent results. Purpose: To review the different imaging patterns of lumbosacral arachnoiditis, their significance, and clinical implications. Study type: Retrospective. Population: A total of 96 patients (43 women; average age 61.3 years) with imaging findings of arachnoiditis (postsurgical: N = 49; degenerative: N = 29; vertebral fracture: N = 6; epidural and subdural hemorrhage: N = 3, infectious: N= 1; other: N = 8) from January 2009 to April 2018. Field strength/Sequence: Sagittal and axial T2‐weighted Turbo Spin Echo at 1.5 T and 3 T. Assessment: Chart review was performed to assess the cause of arachnoiditis, and imaging was reviewed by two musculoskeletal and three neurology radiologists, blinded to the clinical data and to each other's imaging interpretation. Previous classification included a three‐group system based on the appearance of the nerve roots on T2‐weighted images. A fourth group was added in our review as "nonspecified" and was proposed for indeterminate imaging findings that did not fall into the classical groups. The presence/absence of synechiae/fibrous bands that distort the nerve roots and of spinal canal stenosis was also assessed. Statistical tests: The kappa score was used to assess agreement between readers for both classification type and presence/absence of synechiae. Results: Postsurgical (51%) and degenerative changes (30%) were the most common etiologies. About 7%–55% of arachnoiditis were classified as group 4. There was very poor classification agreement between readers (kappa score 0.051). There was also poor interreader agreement for determining the presence of synechiae (kappa 0.18) with, however, strong interreader agreement for the presence of synechia obtained between the most experienced readers (kappa 0.89). Data Conclusion: This study demonstrated the lack of consensus and clarity in the classification system of lumbar arachnoiditis. The presence of synechia has high interreader agreement only among most experienced readers and promises to be a useful tool in assessing arachnoiditis. Evidence Level: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Background: Spinal arachnoiditis is an insidious disease caused by an inflammatory process of the arachnoid membrane resulting from many possible causes. Several factors such as spinal surgery, myelography, or infectious meningitis are known to cause adhesive arachnoiditis. Multiple studies proposed that the initial stage of syringomyelia in spinal arachnoiditis would be intramedullary cystic degeneration caused by ischemia due to circulatory disturbance in the pia-arachnoid. Disturbance of cerebrospinal fluid flow around the spinal cord has an important role in the development of syringomyelia due to spinal arachnoiditis. The presentation of spinal arachnoiditis depends on the level of the disease. For instance, Lumbar or lumbosacral adhesive arachnoiditis is usually related to lumbar disc diseases, and radicular pain due to involvement of the cauda equina is the main symptom. Our case represents a rare cause of arachnoiditis for a patient was presented with lower limb weakness and found to have extensive syringomyelia. Case description: 29-year-old male patient, presented with 3 days history of progressive lower limbs weakness. He had 3 months history of mild lower back pain and subjective left lower limb weakness. MRI showed extensive intramedullary hyperintense lesion extending from T3 to L1 with scattered post-contrast nodular enhancement. Diagnosis of arachnoiditis with syringomyelia done. The patient underwent Thoracic 8 laminectomy, arachnoid biopsy, and syrinx to subarachnoid space shunt. Tissue culture-confirmed Staphylococcus cohnii. Conclusion: Arachnoiditis is a common pathology with multiple causes. However, isolated bacterial arachnoiditis is rare and has not been mentioned in literature before to our knowledge. We present a case of arachnoiditis proven to be bacterial by tissue culture from the thickened arachnoid layer we took during the surgery after we exclude all other causes.

Arachnoiditis is a rare clinical entity that usually presents with severe debilitating radiating pain that can pose a challenge in diagnosis especially in areas without appropriate imaging modalities. We present a 26-year-old male with progressive lower back pain with radiation to the lower extremities, aggravated by movement and touch. We diagnosed idiopathic arachnoiditis based on cerebrospinal fluid analysis and magnetic resonance imaging. He was managed with a 5-day course of methylprednisolone and analgesics with a good outcome. Severe back pain without a specific cause in a young patient should be investigated with proper imaging modalities and lumbar puncture if warranted to evaluate the cause. [ABSTRACT FROM AUTHOR]

• Syringomyelia is a rare but serious complication of tuberculous meningitis. • TB syringomyelia is often refractory to both surgical and medical management. • Surgery does not have significantly better outcomes than medical management. Determinants of tuberculosis (TB) syringomyelia, its management options and outcomes are still under investigation. The aim of this study is to present a case of TB syringomyelia with markedly improved symptoms status-post surgery and to understand the clinical characteristics and outcomes of 33 TB syringomyelia cases reported in the literature. Specifically, we examined the differences between patients who were managed medically and those who underwent surgical intervention. Inclusion criteria for the cases were (1) syringomyelia caused by TB infection rather than co-occurrence of these conditions, (2) management protocol described, and (3) post-treatment outcome described. The median age was 30 years (interquartile range (IQR): 23–40) with 55% males. The median time between TB onset to syringomyelia diagnosis was 2 years. Nineteen patients were surgically treated, 11 were medically treated, and 3 received no treatment. Twenty-one patients showed improvement in at least one prior symptom, but no patient experienced a full recovery. Those that underwent surgical intervention were more likely to have TB meningitis (95% vs. 64%, p < 0.05) upon initial TB presentation and have a greater interval between TB onset and syringomyelia presentation (median of 2.6 vs. 0.33 years, ns). A greater proportion of the surgically managed patients experienced improvement in any symptom (74% vs. 45%, ns). Future case-controlled studies with larger sample sizes are required to validate and further understand the outcomes of surgically-managed TB syringomyelia. [ABSTRACT FROM AUTHOR]

Abstract Background Autologous epidural blood patch (AEBP) is effective for post-dural-puncture headache (PDPH). In some cases, repeat procedures are required for complete cure. In rare instances, severe adverse effects can occur. We present a case of neurologically complicated AEBPs, one of which was performed at the interspace of unintentional dural puncture (UDP). Case presentation A 40-year-old primigravida sustained UDP at the L2–3 interspace during combined spinal-epidural anesthesia for a scheduled cesarean section. She developed PDPH and underwent a single AEBP at L3–4. The PDPH recurred and she required another AEBP at L2–3, after which she reported radicular pains. A diagnosis of subdural hematoma and adhesive arachnoiditis was made. Her symptoms partially resolved in the following months. Conclusion It may be prudent to reconsider the use of repeated AEBP and to avoid the interspace of UDP. A thorough evaluation is warranted to exclude treatable lesions when adverse effects occur.

Elon Eisenberg,1,2 Rephael Goldman,3 Dorit Schlag-Eisenberg,4 Anat Grinfeld5 1Pain Research Unit, Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel; 2B. Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel; 3Amitim Clinic, Haifa, Israel; 4Department of Medical Imaging, Carmel Medical Center, Haifa, Israel; 5Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel Abstract: Lumbar epidural steroid injections (LESIs) are commonly used for managing lower back pain (LBP) and radicular pain. LESIs are generally considered safe with only rare serious complication. One very rare complication that is frequently cited in the literature is adhesive arachnoiditis. However, a literature search failed to detect even one published manuscript, clearly documenting LESI induced arachnoiditis. This article presents two patients who received a transforaminal L5–S1 and two L3–L4 interlaminar LESIs. Although the presented patients developed clear radiological (MRI) findings of arachnoiditis, they were not accompanied by any improvement or deterioration in their clinical condition. The article also reviews the literature on the prevalence, pathogenesis, diagnosis, and clinical features of adhesive arachnoiditis. Literature suggests that adhesive arachnoiditis following LESIs is a rare entity, which – as seen in our patients – has clear radiological characteristics but uncertain pathogenesis. It has a large spectrum of clinical presentation, ranging from an incidental finding to a serious neurological sequela. In at least some patients with adhesive arachnoiditis following LESI, the radiological and clinical findings may fail to correlate with each other. In light of the fact that LESI is one of the most commonly performed procedures for managing LBP, clinicians should be aware of this rare yet existing entity. Keywords: sciatica, spinal stenosis, magnetic resonance imaging, MRI, radicular pain

This article aims to familiarize the reader with the MR imaging findings of tubercular radiculomyelitis (TBRM) and to identify the sources of infection. We evaluated 29 patients on a 1.5 T GE MRI in a cross-sectional study. MRI of the spine with contrast and lumbar puncture were performed in all patients. MRI brain was performed for 13 patients. The typical and atypical manifestations enlisted in this article, will enable early detection of TBRM when the clinical history is ambiguous, as TBRM can present with low backache in both retrovirus positive and negative patients.

Neurocysticercosis (NCC) is the commonest parasitic infection of the central nervous system. There is significant difference in incidence of NCC depending on geographic location, and incidence as high as 4% is reported in the endemic areas. It results from human affliction by the larval stage of Taenia solium. Spinal NCC is quite rare as compared with cranial NCC and accounts for 1.5%–3% of all cases. Both spine and cranium can be rarely involved in NCC, and cranial involvement usually precedes the spinal involvement. We report a case of a 51-year-old woman who had spinal involvement first in the form of spinal intradural extramedullary disease and then developed cranial involvement more than 1 year later. She developed spinal arachnoiditis. She developed communicating hydrocephalous requiring ventriculoperitoneal shunt. Later she developed isolated fourth ventricle and required excision of the fourth ventricular NCC. The unique aspects of our patient were a very aggressive course and involvement of cranium after spinal involvement. We describe her clinical course over 3 years and the management done. NCC can sometimes follow a very aggressive course and can involve both cranial and spinal compartments. Management of such patients is not standardized given the rarity of such cases. [ABSTRACT FROM AUTHOR]

Objective: To report a case of arachnoiditis as a complication of epidural blood patch procedures and to systematically review the diagnostic workup, clinical outcomes, and treatment modalities reported in the literature. Background: Epidural blood patching is an effective treatment for low‐pressure headache secondary to spontaneous cerebrospinal fluid leak or iatrogenic post‐dural puncture. Spontaneous intracranial hypotension is believed to be a rare headache disorder, but recently has been diagnosed at higher frequencies, making it an important differential diagnosis for intractable headaches. Arachnoiditis has surfaced as a rare complication of epidural blood patching. Symptom presentation does not always correlate with evidence of meningeal enhancement on imaging. Optimal methods for treatment remain largely unknown. Methods: Databases Embase and PubMed were searched for all published studies on arachnoiditis post‐epidural blood patch using a combination of the following medical subject headings and keywords: arachnoiditis, arachnoid inflammation, adverse event, and epidural blood patch. All original English‐language articles that described arachnoid and/or meningeal inflammation in conjunction with epidural blood patch procedures were included for analysis. Title and abstract screening, data extraction, and risk of bias assessment were conducted independently and in duplicate by two reviewers. Results: Seven other cases of arachnoiditis post‐blood patch placement have been documented, most of which were diagnosed via magnetic resonance imaging. Six of these were a result of a spinal‐epidural anesthesia for labor and delivery. Common symptoms reported were headache, back and radicular pain, paresthesia, and motor weakness. There are currently no proven consensus‐based treatment recommendations available. While intravenous methylprednisolone followed by oral prednisone taper was found to be effective in the case presented, the benefit of other multi‐modal therapies was unclear. Conclusions: Headache specialists who treat postural headache should be aware of arachnoiditis as a potentially severe complication of epidural blood patch. The case presented is the first of its kind to report arachnoiditis as a complication of high‐volume blood patch for the treatment of spontaneous intracranial hypotension. More studies are required to determine suitable treatment options for post‐epidural blood patch arachnoiditis. [ABSTRACT FROM AUTHOR]

Blindness and vision impairment are unpredictable complications of tuberculous meningitis (TBM) that are often unrecognized in the acute stages of illness due to inability to assess vision in patients with depressed levels of consciousness or confusion. We present a patient with definite TBM confirmed by positive Xpert MTB/RIF assay of cerebrospinal fluid (CSF) who developed binocular blindness two weeks after diagnosis and initiation of standard anti-tuberculosis treatment (ATT). Ophthalmological exam demonstrated complete bilateral abducens nerve palsies, impaired pupillary responses to light, normal optic discs, and visual acuity of hand motion only in each eye. Brain CT showed progressive enlargement of the third and lateral ventricles. We managed the patient medically with dexamethasone, acetazolamide, and substitution of moxifloxacin for ethambutol. Serial brain CTs confirmed gradual resolution of hydrocephalus. The patient had complete neurological recovery at six months except for residual blindness in the right eye. Visual acuity in the left eye recovered to normal (20/20). The assessment and management of vision impairment in TBM is discussed.

This article addresses the implementation of malaria fever therapy in Spain. Neuropsychiatrist Rodríguez-Lafora first used it in 1924, but Vallejo-Nágera was the main advocate for the technique. He had learned the method from Wagner von Jauregg himself, and he worked in the Military Psychiatric Clinic and the San José Mental Hospital, both in Ciempozuelos (Madrid). Vallejo-Nágera worked with the parasitologist Zozaya, who had travelled to England with a Rockefeller Foundation grant in order to learn from British malariologist, Sydney Price James. This article details the results of the uneven implementation of this treatment in Spanish psychiatric institutions. Although syphilologists and internists used fever therapy for the treatment of general paralysis of the insane, they were much less enthusiastic than psychiatrists. [ABSTRACT FROM AUTHOR]

Background The largest health care–associated infection outbreak in the United States occurred during 2012–2013. Following injection of contaminated methylprednisolone, 753 patients developed infection with a dematiaceous mold, Exserohilum rostratum. The long-term outcomes of these infections have not been described. Methods This retrospective cohort study of 440 of a total of 753 patients with proven or probable Exserohilum infection evaluated clinical and radiographic findings, antifungal therapy and associated adverse effects, and outcomes at 6 weeks, 3, 6, 9, and 12 months after diagnosis. Patients were grouped into 4 disease categories: meningitis with/without stroke, spinal or paraspinal infections, meningitis/stroke plus spinal/paraspinal infections, and osteoarticular infections. Results Among the 440 patients, 223 (51%) had spinal/paraspinal infection, 82 (19%) meningitis/stroke, 123 (28%) both, and 12 (3%) osteoarticular infection. Of 82 patients with meningitis/stroke, 18 (22%) died; among those surviving, 87% were cured at 12 months. Only 7 (3%) of 223 patients with spinal/paraspinal infection died, but at 12 months, 68% had persistent or worsening pain and only 47% were cured. For the 123 patients with both meningitis/stroke and spinal/paraspinal infection, 10 (8%) died, pain persisted in 72%, and 52% were cured at 12 months. Only 37% of those with osteoarticular infection were cured at 12 months. Adverse events from antifungal therapy were noted at 6 weeks in 71% of patients on voriconazole and 81% on amphotericin B. Conclusions Fungal infections related to contaminated methylprednisolone injections culminated in death in 8% of patients. Persistent pain and disability were seen at 12 months in most patients with spinal/paraspinal infections. [ABSTRACT FROM AUTHOR]

Background: Dermoid cysts in the myelomeningocele (MMC) site are thought to arise in a delayed fashion because of iatrogenic implantation of dermoid elements at the time of the initial repair surgery. However, there have been few reports on dermoid elements already present at birth. Clinical presentation: We report a patient, in whom dermoid cyst was located at dorsal aspect of the conus medullaris in the MMC sac. Between 23+3 and 24+4 weeks of gestation, rupture of the MMC sac occurred. At this time of gestation, we speculate that rupture of the dermoid cyst also occurred and dissemination of the cyst contents caused chemical arachnoiditis in the MMC sac. At the age of 1 day, surgery to repair MMC and postoperative histological findings revealed these rare pathologies. Conclusion: Physicians should be aware of the possibility of rupture of a dermoid cyst in the MMC sac during fetal period. [ABSTRACT FROM AUTHOR]

Although most of the medical terminology used in pathology derives from the regular forms for the formation of words, there are many terms coined from a proper name called eponyms, where mythonyms (medical terms related to Greek, Roman mythology among others) have a special chapter. Although some terms are derived from mythological figures, others are Greek words related to those figures and therefore have a common origin. Although their number is small, the knowledge of these words enriches our teaching of the pathology and the ability to understand how those who initially described a disease interpreted it. This review will cover the terms achantosis, arachnoiditis, cyclopia, eosin, hermaphrodite, Janus kinase, Klotho protein, lymphoma, caput medusae, chimera, sirenomelia, syringoma and triton tumor, terminology widely used today in our daily work as pathologists. [ABSTRACT FROM AUTHOR]

La neurocisticercosis es la primera causa de parasitosis del sistema nervioso central y de epilepsia adquirida en países en desarrollo. Sus manifestaciones clínicas, especialmente de la variante racemosa (sic), son pleomorfas e inespecíficas, características que hacen de su diagnóstico un desafío para el clínico. El objetivo de este informe fue describir dos casos de neurocisticercosis racemosa (sic), en los cuales las neuroimágenes permitieron hacer el diagnóstico definitivo. El primer caso se trató de una paciente con cefalea persistente y signos neurológicos focales, que requirió múltiples exámenes paraclínicos para, finalmente, llegar al diagnóstico definitivo de neurocisticercosis racemosa (sic) con vasculitis cerebral secundaria. A pesar del tratamiento médico y quirúrgico, la paciente falleció después de diversas complicaciones. El segundo caso se trató de una paciente con antecedentes de neurocisticerosis, que consultó por vómito crónico incoercible y, también requirió múltiples exámenes paraclínicos para concluir que se trataba de un vómito de origen central, secundario a neurocisticercosis racemosa (sic) y obstrucción del cuarto ventrículo. Después del tratamiento médico y quirúrgico, la paciente presentó una leve mejoría. En estos dos casos se evidenció que la adecuada interpretación de las neuroimágenes es fundamental para el diagnóstico de la neurocisticercosis racemosa (sic).

We present a case of a progressive symptomatic intramedullary cyst, diagnosed decades after Lipiodol injection. Lipiodol was originally administered intrathecally for the radiologic diagnosis of spinal masses. A link between the lesion and the history of Lipiodol injection was never suspected. Surgical exploration revealed a membrane above the lesion, separating the intradural space in a cranial and caudal compartment. On the level of the cyst, we identified glassy pearls containing a fatty liquid, compatible with Lipiodol deposits. We hypothesize that the syrinx is secondary to the impact of cerebrospinal fluid pulsations on the reactive membrane and that this membrane originated from an arachnoiditis caused by Lipiodol deposits. Lipiodol was indeed abandoned after it was found to cause arachnoiditis and neurologic sequelae. Despite the cessation of its usage, the causal role of Lipiodol in arachnoiditis and spinal cyst formation should still be considered, as symptoms may arise many years after Lipiodol administration. [ABSTRACT FROM AUTHOR]

Central Nervous System (CNS) tuberculosis is a common disease in developing countries with varied presentation, the most common being tuberculous meningitis. Meningitis, in many cases leads to infection of the underlying cortex resulting in cerebritis, encephalitis or abscess formation. Tuberculous cerebritis has either been described as a focal entity in normal subjects or as a diffuse entity in immunocompromised hosts. We present here two cases of diffuse tuberculous cerebritis in immunocompetent patients. One had presented with left focal seizure with paraparesis while the other presented with non-localising features of raised intracranial pressure. Tubercular Polymerase Chain Reaction (PCR) was positive in Cerebrospinal Fluid (CSF) in the first patient while CSF picture was suggestive of tubercular meningitis in the second, making him a possible case of tuberculosis. Both the patients improved significantly on anti-tubercular drugs.

Spinal adhesive arachnoiditis is an inflammation and fibrosis of the subarachnoid space and pia mater caused by infection, trauma, spinal vascular anomalies, and iatrogenic (surgery and/or puncture). Adhesive arachnoiditis develops various symptoms and signs (gait disturbances, radiating pain, paralysis, and incontinence). On the other hand, adhesive arachnoiditis associated with cauda equina syndrome has not been reported in Korea until now. The authors experienced cauda equina syndrome caused by adhesive arachnoiditis of the lumbar spine with satisfactory results following decompression. We report this case with a review of the relevant literature. [ABSTRACT FROM AUTHOR]

Background: Neurovascular conflict is considered a key element of classical trigeminal neuralgia (TN) and consequently, microvascular decompression (MVD) is an effective treatment. Nevertheless, failures of MVD are described by many authors. In some patients, the arachnoid membranes surrounding the trigeminal nerve and neighbouring vessels may be thickened and adhesive. Here we analyse the impact of such focal arachnoiditis on outcome after MVD for TN. Methods: A cohort of prospectively followed patients after their MVD was reviewed for intraoperative, imaging and clinical data if findings of arachnoiditis during MVD were described. Long-term outcome assessment was the main endpoint. Results: We reviewed data from 395 MVD procedures, performed for TN from 2001 to 2014. Intraoperative evidence of focal arachnoiditis, as described by the surgeon, has been noted in 51 patients (13%). In 35 (68.6%), neuralgia was typical and in the other 17 (31.4%) it was atypical. As expected by definition, neurovascular conflict was found in 49 interventions (96%); it was predominantly arterial in 27 (52.9%). Accompanying arachnoiditis was encountered: mild in 20 interventions (39.2%), severe in 31 (60.8%). A successful result (BNI I or II) was achieved in 29 patients (56.9%). The other 22 patients (43.1%) had persistence or recurrence of pain. Overall KM probability of being pain free at 15 years was 72%. Conclusions: Intraoperative finding of arachnoiditis during MVD for classical trigeminal neuralgia is associated with poorer outcome than that of classical trigeminal neuralgia in general. This is particularly true for low grades of conflict. [ABSTRACT FROM AUTHOR]

Arachnoiditis ossificans (AO) is a rare entity characterized by the presence of calcified plaques formed by the metaplasia of arachnoid cells. Over 50 cases of AO have been reported, with predisposing factors including spinal trauma, hemorrhage, vascular abnormalities, and infection. The administration of oil-based contrast during myelography as an independent risk factor or in conjunction with other spinal pathology has been described in 9 cases. A 70-year-old woman presented for neurosurgical consultation in 2013 with a 2-year history of progressive midthoracic pain, right-sided chest wall allodynia, lower extremity weakness, and gait ataxia. Approximately 30 years ago, she received an oil-based contrast myelogram for investigation of spontaneous spinal hemorrhage. The procedure was well tolerated, and the patient experienced no allergic, hemorrhagic, traumatic, or infectious complications. No etiology was found for the spinal hemorrhage, and the patient recovered fully from that episode. Magnetic resonance imaging (MRI) of the thoracolumbar spine demonstrated multiple compressive intradural lesions in the upper thoracic spine and ventral tethering of the spinal cord at T7. MRI also demonstrated syringomyelia throughout the thoracic spine. Initially, the diagnosis of epidural mass or diastematomyelia was considered. To further characterize the epidural lesion, an unenhanced computed tomography (CT) scan was obtained, demonstrating a long segment of extensive calcification in the periphery of the thoracolumbar spine, with near-complete circumferential involvement from T5 to T11. The diagnosis of AO with extensive thoracic spine calcifications, syringomyelia, and spine cord tethering was made and confirmed at surgery. In addition to acute inflammation, oil-based contrast myelography also leads to arachnoiditis, calcification, and retained mass lesions because of its chronic inflammatory properties and slow resorptive rate. Three decades after its replacement with water-based contrast material, the chronic sequelae of oil-based contrast myelography may continue to manifest clinically and on CT imaging. Because of calcifications often encasing the spinal cord or nerve roots, management of AO is challenging, and neurologic deficits may persist even after surgery. [ABSTRACT FROM AUTHOR]

Background and Objectives: As the number of people with tattoos has been increasing, anesthesiologists are more and more faced with the decision to perform a neuraxial blockage through tattooed skin. In this study, we evaluated the possibility of puncture through tattooed skin determines acute inflammatory changes in the meninges and spinal cord and later evolve into adhesive arachnoiditis.Method: Forty-two male rabbits were randomized into 3 groups of 14: G1, spinal puncture through non-tattooed skin and saline solution injection; G2, spinal puncture through tattooed skin and saline solution injection, captive for 30 days; G3, spinal puncture through tattooed skin and saline solution injection, captive for 360 days. The animals were anesthetized and ultrasound-guided spinal puncture was performed in the intervertebral spaces between S1 - S2. During the period of captivity, the animals were clinically assessed for sensitivity and motor function. After that, they were sacrificed and the lumbosacral portion of the spinal cord was excised for histological analysis.Results: No histological changes were found on group 1. Eleven animals from group two presented with foci of perivascular lymphocytic inflammatory infiltrate in the pia mater and/or arachnoid. In Group 3, eight rabbits presented with inflammatory changes in the meninges, which were associated with thickening and/or adhesion of the pia mater and arachnoid in some cases and five rabbits presented only thickening of pia-mater.Conclusions: Spinal puncture through tattooed skin of rabbits can trigger acute inflammatory changes in the meninges and after a prolonged period of observation evolve into adhesive arachnoiditis. [ABSTRACT FROM AUTHOR]

Medical records (2004–2016) of five dogs with a thoracolumbar spinal arachnoid diverticula (SAD) that was diagnosed with stress myelography in four dogs and magnetic resonance imaging in three, and who had hemilaminectomy, diverticular marsupialization, and vertebral stabilization, were reviewed. Data on previous treatment, pre- and postoperative neurologic status, diagnostic findings, surgical techniques, and outcomes was retrieved. Follow-up clinical and radiographic evaluations were performed immediately; ∼1, 2, and 6 mo postoperatively; and at annual follow-up examinations. The stress myelography demonstrated spinal cord dynamic compression in three of four dogs and change in size or shape of the SAD in all four. Two dogs who had SAD recurrences 4 and 13 mo after previous surgical dural fenestration, and one dog with no previous SAD treatment demonstrated long-term neurological improvement after vertebral stabilization (49, 77, and 126 mo). In two other dogs, recurrence of clinical signs was observed at the follow-up (8 and 12 mo). This case series suggested that repetitive spinal cord injury from the dynamic lesion appears to be one potential cause of thoracolumbar SADs. In cases with dynamic lesions confirmed by stress myelography, vertebral stabilization with conventional techniques is indicated to prevent SAD recurrence. [ABSTRACT FROM AUTHOR]

A case study is presented for a 41-year-old female patient suffering from a 15-year history of chronic relapsing meningitis which progressed to lumbar arachnoiditis. It states that despite multiple treatment regimens for tuberculosis, inflammation, and herpesviral infections the meningitis recurred. It mentions that despite a family history of cancer, the patient showed no evidence of malignancy in repeated cerebrospinal fluid cytology and flow cytometry examinations.

This article reviews the causes, pathogenesis, and major manifestations of chiasmal syndrome. In addition, it reviews the methods for diagnosing the condition, and the course of the syndrome in patients with various chiasmal-and-sellar disorders such as pituitary adenoma, craniopharyngioma, tuberculum sellae meningioma, and skull base aneurysm. The principle neuro-ophthalmological symptoms include decreased visual acuity, bitemporal visual field defects, and development of descending optic nerve atrophy. Early detection of ophthalmological symptoms is of critical importance for timely neurosurgical treatment. [ABSTRACT FROM AUTHOR]

Background & Objectives: Arachnoiditis which involves the optic chiasm and optic nervecan rarely occurs in the patients with tuberculous meningitis (TBM). The primary objective of this study was to determine the incidence, assess the clinical and neuroimaging findings, and associations, understand its pathogenesis of these patients, and determine its prognosis. Methods: The patients admitted with TBM in the neurology wards of two tertiary care hospitals from 2009 to 2017 in Kuala Lumpur, Malaysia were screened. The patients with OCA and optochiasmatic tuberculoma were included in this study. We assessed the clinical, cerebrospinal fluid (CSF), imaging findings of the study subjects and compared with other patients without OCA or optochiasmatic tuberculoma. Results: Eighty-eight patients with TBM were seen during the study period. Seven (8.0%) had OCA and one (1.1%) had optochiasmatic tuberculoma. Five out of seven (71.4%) patients with OCA were newly diagnosed cases of TBM. The other two (28.6%) had involvement while on treatment with antituberculous treatment (paradoxical manifestation). The mean age of the patients with OCA was 27.3 ± 11.7. All the OCA patients had leptomeningeal enhancement at other sites. All had hydrocephalus and cerebral infarcts on brain neuroimaging. Three (42.9%) patients had cerebral tuberculoma at sites other than suprasellar and optic chiasm areas. On univariate analysis, the presence of OCA and optochiasmatic tuberculoma was associated with raised CSF opening pressure (p=0.014), younger age (p=0.024), cerebral infarcts (p=0.018) and hydrocephalus (p= 0.046). There was no statistically significant association on logistic regression. Only one (14.3%) patient had visual impairment. Conclusion: OCA and optochiasmatic tuberculoma were seen in 9% of a cohort of Malaysian TBM patients. They were more likely to be younger, have raised CSF opening pressure, cerebral infarcts and hydrocephalus, suggesting the association with a more severe exudative disease. [ABSTRACT FROM AUTHOR]

Subarachnoid neurocysticercosis (NCC) is a form of NCC with cysticerci located in the subarachnoid space. This form of NCC can cause general and focal neurologic symptoms, and sometimes requires surgical intervention as a treatment. In this report, we present a rare case of hemifacial spasm secondary to arachnoiditis because of an NCC cyst in the cerebellopontine angle. The cysticercus was removed and the facial nerve was liberated via a retrosigmoidal approach. At 8-month follow-up, the patient reported no recurrence of symptoms. To our knowledge, this is the first case reported to surgically manage hemifacial spasm secondary to NCC arachnoiditis. [ABSTRACT FROM AUTHOR]

Compared to the outer dura mater, the mechanical behavior of spinal pia and arachnoid meningeal layers has received very little attention in the literature. This is despite experimental evidence of their importance with respect to the overall spinal cord stiffness and recovery following compression. Accordingly, inclusion of the mechanical contribution of the pia and arachnoid maters would improve the predictive accuracy of finite element models of the spine, especially in the distribution of stresses and strain through the cord’s cross-section. However, to-date, only linearly elastic moduli for what has been previously identified as spinal pia mater is available in the literature. This study is the first to quantitatively compare the viscoelastic behavior of isolated spinal pia-arachnoid-complex, neural tissue of the spinal cord parenchyma, and intact construct of the two. The results show that while it only makes up 5.5% of the overall cross-sectional area, the thin membranes of the innermost meninges significantly affect both the elastic and viscous response of the intact construct. Without the contribution of the pia and arachnoid maters, the spinal cord has very little inherent stiffness and experiences significant relaxation when strained. The ability of the fitted non-linear viscoelastic material models of each condition to predict independent data within experimental variability supports their implementation into future finite element computational studies of the spine. Statement of Significance The neural tissue of the spinal cord is surrounded by three fibrous layers called meninges which are important in the behavior of the overall spinal-cord-meningeal construct. While the mechanical properties of the outermost layer have been reported, the pia mater and arachnoid mater have received considerably less attention. This study is the first to directly compare the behavior of the isolated neural tissue of the cord, the isolated pia-arachnoid complex, and the construct of these individual components. The results show that, despite being very thin, the inner meninges significantly affect the elastic and time-dependent response of the spinal cord, which may have important implications for studies of spinal cord injury. [ABSTRACT FROM AUTHOR]

Background We present a case of delayed progression of adhesive arachnoiditis to arachnoiditis ossificans (AO) in a patient being treated with a high-dose polypharmaceutical intrathecal regimen. Case Description The patient is a 39-year-old Caucasian male who was implanted with an intrathecal pump in 2006 to control severe low back pain and administered intrathecal pain medication for a period of 10 years. In 2016, he developed new-onset radicular pain and worsened sensation in his lower extremities. Computed tomography scan of the lumbar spine at that time demonstrated profound calcification of the arachnoid consistent with a diagnosis of AO. It was presumed that prolonged high-dose intrathecal medication precipitated this condition, and his intrathecal medications were titrated down with removal of the pump. Conclusions It is unlikely that his condition occurred as a result of prior surgery, with the more likely cause being hyperplasia of the spinal arachnoid, leading to scarring and calcification, due to the high-dose intrathecal regimen. This case highlights the delayed progression from stable arachnoiditis to AO concurring with a regimen of high-dose intrathecal medications. Clinicians should closely monitor patients undergoing intrathecal drug administration, particularly at elevated doses, for indications of damage to the spinal arachnoid mater. [ABSTRACT FROM AUTHOR]

Purpose: Metal implants have been used to treat adolescent idiopathic scoliosis since the 1960s. Only recently, however, it has the issue of metal-bone breakdown secondary to metal corrosion in situ come to light, raising concerns of possible long-term complications from the resulting metallosis and inflammation of spinal tissues. We present a case of a patient with neurological deficit, pain, and disability with Harrington rod in place for over 30 years, to bring attention to the issue of bio-corrosion of metal implants and its effect on human tissue. We call attention to the need for protocols to better diagnose and treat these patients.Methods: We provide a complete review of the history and clinical manifestations as well as serum metal, X-ray, and CT/myelogram test results.Results: A 52-year-old female with spinal fusion and Harrington rod presents with pain, lymphedema, disability, and neurological deficits including thoracic outlet syndrome, hyperreflexia, peripheral muscle weakness and atrophy, hypertonicity, Raynaud's phenomenon, and balance and gait abnormalities. Serum chromium levels were elevated (26.73 nmol). X-rays showed no evidence of rod breakdown. Serial X-rays can demonstrate subtle corrosive changes but were not available. Adhesive arachnoiditis was diagnosed via CT/myelogram.Conclusion: We hypothesize that bio-corrosion is present in this case and that it is associated with intraspinal metallosis. Trauma secondary to a motor vehicle accident, as well as arachnoiditis, and their possible effects on this case are outlined. Challenges in proper diagnosis and management are discussed. [ABSTRACT FROM AUTHOR]