1/18. syringomyelia--as a late complication of tuberculous meningitis.The aim of this paper is to demonstrate the unusual MR features of thoracic syringomyelia following TB meningitis and to discuss the neurosurgical aspect of the treatment of this rare entity. Four years after a TB meningitis episode, a 30 year-old female patient developed a progressive spastic paraparesis. MR studies revealed multiloculated syrinxes throughout the thoracic cord. She had a syringo-subarachnoid shunt with a silastic "T" tube inserted. On the first postoperative day, she showed a dramatic neurological improvement, but unfortunately her paraparesis progressed to the preoperative level within a month despite diminished size of the syrinxes on the control MRI examination. Two and a half years after the operation the patient complained of having a burning type of central pain, and further deterioration in neurological function. Thoracic spinal MRI examination demonstrated enlarged syringomyelic cavities. At the second operation syringo-peritoneal shunt insertion was performed via right T10-11 hemilaminectomy using a "T" tube. At present, 4 months after the second operation, the patient's neurological examination demonstrated decreased spasticity, and improved strength in the legs compared to the preoperative level. MRI is the first choice of investigation in detecting TB related myelopathy as it provides a greater detail of pathological changes within and around the spinal cord such as syrinx formation and arachnoiditis. The MR findings are also helpful in deciding the management and predicting the outcome. Presence of multifocal loculations and arachnoid adhesions is the likely cause of treatment failures and poor prognosis.- - - - - - - - - - ranking = 1keywords = arachnoiditis (Clic here for more details about this article) |
2/18. Tuberculous meningitis with spinal tuberculous arachnoiditis.This report is of a 36-year-old woman who initially presented with confusion and fever. Subsequent investigations showed tuberculous meningitis with acute hydrocephalus. ventriculoperitoneal shunt was performed and anti-tuberculosis therapy was given. The patient was later noticed to have weakness of both lower limbs and urinary retention. magnetic resonance imaging of the thoracic spine showed radiological features of tuberculous arachnoiditis with cord compression. Decompressive laminectomy was performed and high-dose systemic corticosteroid was given. A high level of awareness is required when diagnosing tuberculous arachnoiditis and the importance of high-dose corticosteroid in the treatment regimen is emphasised.- - - - - - - - - - ranking = 6keywords = arachnoiditis (Clic here for more details about this article) |
3/18. Breakthrough neurological manifestation during appropriate antituberculous therapy of miliary tuberculosis.We report a 20-month-old girl with miliary pulmonary tuberculosis and normal neurological findings. While on treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol for 1 month, she developed weakness of the lower extremities without meningism or altered consciousness. A computerized tomogram revealed tuberculomas and basal arachnoiditis. The cerebrospinal fluid findings were compatible with tuberculous meningitis. She responded well to systemic corticosteroids.- - - - - - - - - - ranking = 1keywords = arachnoiditis (Clic here for more details about this article) |
4/18. Subarachnoid spread of germinoma mimicking tuberculous meningitis.A case of pineal germinaoma spreading along the basal subarachnoid space, clinically and macroscopically at autopsy, resembling tuberculous basal arachnoiditis is reported. Need to carry out CSF cytology of even hemorrhagic CSF is stressed, to diagnose the condition.- - - - - - - - - - ranking = 1keywords = arachnoiditis (Clic here for more details about this article) |
5/18. MRI of spinal intradural arachnoid cyst formation following tuberculous meningitis.Secondary intradural arachnoid cyst involving the spine is uncommon. It is usually secondary to trauma, haemorrhage, surgery or inflammation. We present two cases of treated tuberculous meningitis, which presented with gradual onset of quadriplegia and paraplegia, respectively. MRI revealed intradural (cervical and thoracic) arachnoid cysts (ventral and dorsal to the spinal cord) with myelomalacic cord changes. Ventral location of such spinal arachnoid cysts, and being secondary to tuberculous arachnoiditis are distinctively uncommon features. The rarity of this condition and the relevance of MRI in the accurate diagnosis have been discussed here.- - - - - - - - - - ranking = 1keywords = arachnoiditis (Clic here for more details about this article) |
6/18. syringomyelia as a complication of tuberculous meningitis.Tuberculous meningitis may rarely be followed by the development of syringomyelia despite appropriate chemotherapy. In the present paper, we report a case of tuberculous meningitis in a 23-year-old Vietnamese male complicated by a rapidly progressive myelopathy due to granulomatous arachnoiditis which culminated in the development of a syrinx. The relevant literature is reviewed. The present case supports the hypothesis that vasculitic thrombosis of spinal cord vessels leading to ischemic myelomalacia is the mechanism causing postinflammatory syringomyelia.- - - - - - - - - - ranking = 1keywords = arachnoiditis (Clic here for more details about this article) |
7/18. Cysticercal chronic basal arachnoiditis with infarcts, mimicking tuberculous pathology in endemic areas.neurocysticercosis (NCC) is the most common of the parasitic diseases affecting the CNS, with protean clinical manifestations. stroke as a complication of NCC occurs in a very small percentage of cases, mostly involving small perforating vessels while major intracranial vessel involvement is extremely rare. The present report involves two autopsied cases of chronic cysticercal basal arachnoiditis causing large arterial territory infarcts and, in the second case, a hypothalamic mass. They were diagnosed and managed, clinically and by neuroimaging, as stroke and neurotuberculosis, respectively. The diagnosis was established only at autopsy, which revealed NCC causing basal arachnoiditis, major vessel vasculitis and infarcts. Histologically, case 1 showed degenerating racemose cysticercal cyst within the thick basal exudate. In the second case, remnants of the degenerated cysticercal cyst in the form of hooklets and calcareous corpuscles were identified within the giant cell inciting a granulomatous response to form a hypothalamic mass lesion mimicking tuberculoma. The present case report highlights the importance of considering the non-tuberculous etiologies of chronic basal arachnoiditis like NCC before initiating therapy especially in countries endemic to both NCC and tuberculosis, like india.- - - - - - - - - - ranking = 7keywords = arachnoiditis (Clic here for more details about this article) |
8/18. Tuberculous radiculomyelitis (arachnoiditis) associated with tuberculous meningitis.Abstract. A 17-year-old man who presented with progressive quadriparesis is reported. About 8 months prior to admission, he had miliary tuberculosis, and that improved with anti-tuberculous therapy. He had also developed tuberculous meningitis and tuberculous myelitis, respectively. He regularly took anti-tuberculous drugs until this illness. Neurological findings were compatible with cervical cord lesion. CSF analysis indicated a predominate lymphocytic pleocytosis with a high protein level and low sugar profile. MRI findings revealed a multi-loculated arachnoid cyst at C1-C3 level with pressure affecting the adjacent spinal cord and evidence of myelitis at C3-T1 level. Hemi-larminectomy and removal of the arachnoid cyst were performed, but without improvement. A CSF culture yielded M. tuberculosis, that was susceptible to anti-tuberculous drugs.- - - - - - - - - - ranking = 4keywords = arachnoiditis (Clic here for more details about this article) |
9/18. arachnoiditis ossificans with arachnoid cyst after cranial tuberculous meningitis.A 34-year-old woman developed symptomatic arachnoiditis ossificans and an arachnoid cyst as a consequence of tuberculous meningitis adequately treated 20 years before. Surgical decompression of the cyst stopped the progression of her spastic paraparesis. Pathologic examination confirmed the presence of ossification of the arachnoid.- - - - - - - - - - ranking = 1keywords = arachnoiditis (Clic here for more details about this article) |
10/18. Bacterial meningitis complicated by spinal arachnoiditis: diagnostic contribution of Tc-99m-inulin myeloscintigraphy.Six cases of bacterial meningitis with myeloscintigraphic evidence of medullary arachnoiditis are reported. Four patients has tuberculous meningitis, another showed severe myelopathy, and the last was suspected to have hydrocephalus. arachnoiditis is suspected when the earliest images show a sharp decrease of tracer concentration. Scintigraphy began 2 hours after lumbar injection of Tc-99m-Polyfructosan and imaging was performed at intervals of 2, 4, and 6 hours. This method has proved easy, innoculous, reproducible, and, owing to the small amount of irradiation, studies may be repeated during and after therapy. Scintigraphy is superior to the Queckenstedt test becaise it detects partial blocks and localizes lesions.- - - - - - - - - - ranking = 5keywords = arachnoiditis (Clic here for more details about this article) |
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