Infectious diseases of various etiologies and localizations after their generalization pose a danger not only from general intoxication, but also as a cause of inflammation of the meninges. As a rule, patients think little about this, and doctors may miss the harbingers of complications.
Definition
Arachnoiditis is an inflammation of the arachnoid membrane of the spinal cord or brain. This separation is arbitrary, since isolated forms are not found in clinical practice. This is due to the device of the vascular system. The infection spreads from the dura or dura mater, so arachnoiditis can be compared with serous meningitis.
The term “cerebral arachnoiditis” is gradually turning into atavism, since it is pathomorphologically and clinically difficult to separate the inflammation of the arachnoid membrane. Doctors are inclined to believe that all manifestations of membrane irritation will be called meningitis.
History and etiology
For the first time, the term "arachnoiditis" in his dissertation introduced Tarasenkov into medicine in the mid-nineteenth century. A more detailed description of this disease was provided by the neurologist Benninghouse. But he called it external serous meningitis.
Arachnoiditis, like inflammation of other membranes, occurs after acute and chronic infectious diseases, sinusitis, against the background of chronic intoxication with heavy metal salts and injuries. In addition, pathology can appear against the background of the oncological process and encephalitis.
The most common cause of arachnoiditis is chronic suppurative otitis media and its complications: labyrinthitis, petrozitis and sinus thrombosis. Therefore, it is localized in the posterior or middle cranial fossa.
The course of the disease is divided into acute, subacute or chronic. And according to the prevalence of the process, spilled and limited arachnoiditis is distinguished. As a rule, they are combined or go one after another in the clinical picture.
Symptoms
How does a disease such as arachnoiditis of the brain manifest itself? Symptoms are a combination of cerebral and local disorders. The former are associated with increased cerebrospinal fluid pressure, and the latter indicate the location of the focus of inflammation. Depending on which symptom complex prevails, the manifestations of the disease may vary.
Most often in the clinic there are complaints of a headache, which is accompanied by nausea and vomiting, which does not bring relief. The pain can be focused in one place, aggravated by movement, mental or physical stress. In addition, there is dizziness (even when lying down), irritability, severe weakness, combined with sleep disturbances. Photophobia, intolerance to loud sounds, muscle rigidity may occur.
But this is not the only thing that manifests arachnoiditis of the brain. Signs of focal disorders depend on the location of the pathological process. If the focus is on the convex surface of the brain, then most likely the patient will experience loss of function, episodes of epileptic seizures. The location of the inflamed tissue on the lower surface of the brain causes disorders of the cranial nerves. These are symptoms such as a decrease in vision or loss of its fields, facial neuritis, trigeminal nerves, and a decrease in sense of smell. They can be combined with manifestations of damage to the autonomic nervous system (excessive sweating, blue skin, thirst, frequent urination, increased blood glucose).
In the system of formation and circulation of cerebrospinal fluid, cerebral arachnoiditis can also be. Symptoms of this condition are manifested in a sharp increase in temperature, vomiting, pain in the neck and back of the head, nystagmus and increased tendon reflexes. In such cases, it is necessary to differentiate pathological symptoms from the development of tumors of the posterior cranial fossa. But lumbar puncture can be performed only if there are no stagnation on the fundus.
Cerebral arachnoiditis
If the inflammatory focus is located on a convex (convexital) surface, then it is called "cerebral arachnoiditis of the brain." Symptoms of it include manifestations of damage to the meninges and impaired fluid outflow. Most often, the first sign is severe headaches. Due to tissue edema, the normal circulation of cerebrospinal fluid will be difficult, which will lead to its accumulation and the development of intracranial hypertension.
Cerebral arachnoiditis of the brain, the symptoms of which can mimic other pathologies, is more often located in the frontal lobe, in the region of the central gyrus. Because of this, motor disorders are often found in the form of increased or loss of movement or sensitivity. With irritation and compression of the cortex, there may be focal epileptiform seizures. In the case of a severe course, large convulsive seizures occur, which can turn into an epileptic status. In such cases, electroencephalography plays an important role. Modern doctors rarely use pneumography because of the specific technique of introducing air under the shell of the brain, although this method of research in this case is also very informative.
Optic Chiasm Arachnoiditis
In clinical practice, in the area of optic nerve intersection, cerebral arachnoiditis is most common. Symptoms of this localization are specific enough for timely diagnosis. Of the causes, malaria, syphilis, head injury and tonsillitis can be distinguished.
Adhesions and cysts with serous contents form in the area of the optic nerve cross, and in especially advanced cases, dense scar tissue appears around the chiasm. This variant of the course of the disease is not strictly local. You can notice changes in the nervous tissue and at a considerable distance from the focus. Due to inflammation, the optic nerves on both sides undergo compression and, as a result, ischemia.
The disease develops slowly, first affecting one eye, and then, after a few weeks, and the other. Throughout the development of the disease, the patient complains of pain behind the eyeballs. This allows for differential diagnosis with neuritis of various etiologies. To determine the site of inflammation, the determination of visual fields and examination of the fundus is used. The most specific is the loss of temporal fields of vision or its concentric narrowing. This indicates that the focus of inflammation is in the center, between the optic tracts.
Arachnoiditis of the posterior cranial fossa
In the posterior cranial fossa, cerebral arachnoiditis of the brain is most often localized. Symptoms resemble tumors of the occipital lobe and consist of cerebellar and stem manifestations (damage to the fifth, seventh and eighth pairs of cranial nerves).
Damage to the cerebellum is manifested in instability in walking and in a static position, impaired coordination of movements of the arms and legs, as well as the inability to simultaneously perform several actions, since the patient needs to visually control his limbs to do everything right.
Symptoms depend on the type of inflammation (cyst or adhesions), its localization and combination with hydrocephalus. The latter can occur due to overlapping openings of the lateral ventricles of the brain as a result of pathological changes in tissues. Excess fluid irritates the meninges and causes an increase in intracranial pressure. The manifestations of this syndrome are a sharp headache, nausea, vomiting, dizziness, palpitations.
Spinal arachnoiditis
This type of lesion occurs when the infectious agent that caused cerebral arachnoiditis enters the spinal cord with the flow of cerebrospinal fluid or blood circulation. Symptoms and consequences depend on the spread of the process and the number of damaged roots. The causes of the development of the disease in addition to the already mentioned may be boils and purulent abscesses.
The clinic for spinal cord lesions is similar to that for extramedullary tumors. The most frequent localization is the thoracic and lumbar segments, the area of the cauda equina. In the cerebrospinal fluid, cell-protein dissociation is observed. As a rule, the spinal form of arachnoiditis is chronic.
Diagnostics
Starting the diagnosis, the doctor first collects an anamnesis of life and health, then conducts a physical examination, including a description of the neurological status. And only after that attracts additional laboratory and instrumental research methods.
First of all, the task of a neurologist is to exclude a brain tumor that can mimic cerebral arachnoiditis. Symptoms, a photo of the skull on a computer or magnetic resonance therapy will help with this. In addition, signs of intracranial hypertension will be visible on the craniogram . The results of echoencephalography, angiography and scintigraphy are also considered informative, but the doctor primarily focuses on MRI.
Electroencephalography helps to localize the foci of inflammation and find out the cause of epileptic seizures. Analysis of cerebrospinal fluid shows a moderate number of cells, slight protein dissociation, but cerebrospinal fluid flows under pressure, which confirms hydrocephalus. In addition, after this procedure, the patient's well-being improves due to a decrease in intracranial pressure.
Treatment
How to treat cerebral arachnoiditis? This task is quite laborious. First you need to find out the cause of the inflammatory reaction and try to eliminate it. For this, broad-spectrum antibiotics are used, which enter the blood-brain barrier. Antihistamines and desensitizing drugs are used to reduce tissue edema .
The treatment of cerebral arachnoiditis is designed for long-term course therapy with agents that absorb scar tissue. In addition, it is necessary to normalize intracranial pressure, improve cerebrospinal fluid outflow, stimulate cerebral circulation and oxygen delivery to nerve tissue.
In general, it is necessary to restore everything that managed to damage arachnoiditis of the brain. Treatment with medications, such as biogenic stimulants, Lidase, Pyrogenal, courses of fifteen injections every six months, gives positive results even in complex cases of the disease. To reduce pressure, diuretics and decongestants are used. Antiepileptic drugs are excellent for stopping convulsive syndrome.
As a prophylaxis, general strengthening therapy is carried out, in the presence of additional problems, symptomatic treatment is performed .
Forecast and Prevention
Timely treatment of arachnoiditis of the brain, as a rule, ends in recovery. The danger can only be the inflammatory process, which is located in the posterior cranial fossa and is accompanied by overlapping ventricular ventricles. The prognosis worsens the frequent recurrence of the disease or its progressive course against the background of hypertensive crises, epileptiform seizures, as well as the localization of inflammation in the projection of visual intersection.
What should be done to prevent cerebral arachnoiditis? The consequences are serious enough, so you should pay attention to your health and turn to a medical institution for help in time. It is necessary to prevent sinusitis, otitis media and frontal sinuses, to be vaccinated according to the calendar, and most importantly, to treat all infectious diseases on time and until the end. Because it is they that lead to the development of arachnoiditis.
Disability
Brain arachnoiditis disease can cause a person to be disabled. Even against the background of relative clinical well-being, the consequences of the infection remain for life.
The third group of disability is assigned to patients who are able to take care of themselves, as well as perform light work. They are encouraged to change their profession and lead the right lifestyle as much as possible.
The patient receives disability of the second group if after treatment he has episodes of epileptic seizures and decreased visual acuity. They can no longer fulfill their professional duties, but are quite capable of serving themselves. Invalids of the first group are considered to be patients who, as a result of the disease, have completely lost their sight.
Patients with the third group are contraindicated to work at height, in an open flame and moving machinery, in transport. It is recommended to exclude difficult meteorological conditions associated with changes in atmospheric pressure, work in noisy gassed rooms, labor associated with vibration.
After the doctor has diagnosed "cerebral arachnoiditis", the symptoms, treatment and rehabilitation of patients are carefully studied by specialists of the medical and social expert commission. Any decision, even the most insignificant detail, can affect the decision to grant the status of a disabled person, since this is followed by certain benefits.