Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
March 2015
Next Case of the Month coming April 7 . . .
Myelopathy and Chronic Spinal Cystic Arachnoiditis after Subarachnoid Hemorrhage
- Chronic spinal cystic arachnoiditis is a rare complication of subarachnoid hemorrhage. It is thought that haemolysis induces an inflammatory reaction of the arachnoid membranes that leads to fibrosis and secondary thickening of the meninges, including the dura. This fibrosis can cause septations and cysts of CSF that can compress the spinal cord, causing myelopathy and syringohydromyelia.
- Clinical Presentation: Progressive symptoms such as lumbar pain, lower limb dysesthesia, and sphincter disturbances. Somesthesic and motor-evoked potentials are usually abnormal.
- Key Diagnostic Features:
- Knowledge of prior medical history
- Spinal MRI demonstrating thickened dura, loculated subarachnoid collections deforming the cord. Increased signal within the cord suggestive of syringohydromyelia and myelopathy.
- Thickened and clumped nerve roots
- DDx:
- Infection (including spinal neurocysticercosis)
- Less likely: Congenital spinal arachnoid cysts
- Rx: Conservative treatment or, in severe cases, surgical decompression, which can be achieved by total excision of the cysts (ideal), fenestration, or placement of a shunt.
Current Issue
Case Collections
