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When I Control the Pain, I Control My Life: Opioids and Opioid-Containing Analgesic Medication in the Management of Chronic Intractable Pain
Published in Michael S. Margoles, Richard Weiner, Chronic PAIN, 2019
As of 1997, Sandra has been on a level dosing of morphine sulfate injection at an average of 300 mg/day since 1993. In 1993, injectable Dilaudid-HP® (about eight times as powerful as morphine sulfate injection) was tried, but it did not help as much as the morphine sulfate injection. At rare times, when her pain flares up from a twist or fall, I allow her to take extra morphine sulfate injection for 3–5 days. She is also on a complete program for MPS management. The myofascial trigger point injections are supplying more pain relief with the passage of time. Other than the morphine sulfate injection, there is no other treatment for her postmyelogram arachnoiditis.
Inflammatory diseases affecting the spinal cord
Published in Milosh Perovitch, Radiological Evaluation of the Spinal Cord, 2019
It is often difficult to diagnose arachnoid adhesions on the basis of the clinical symptomatology. Symptoms, if apparent, are not constant and frequently have an insidious onset with an intermittent course. The appearance of multiple levels of segmental sensory disturbances favors the diagnosis of chronic arachnoiditis with adhesions. Root pains are of a diffuse type, and they are not localized to the cutaneous distribution of one or several spinal roots. The pain can be intensified by movements or coughing, sneezing, or straining. Paralysis, partial or complete loss of sphincter control, and muscular wasting may develop later. Patchy areas of dysesthesia or hyperesthesia were found, and they were similar to those encountered in intrinsic diseases of the spinal cord.69 In the domain of the cauda equina, the radicular disturbances are similar to those caused by disk herniation, and indeed, it is often impossible to exclude the coexistence of a disk prolaps. The variability of clinical symptoms and their appearance weeks, months, and often years following the causative pathologic process makes the clinical diagnosis of chronic arachnoiditis and adhesions rather indeterminate.
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Published in Anton Sebastian, A Dictionary of the History of Medicine, 2018
Arachnoiditis [Greek: arachne, spider] Inflammation of the spinal canal. Described in a patient as ‘meningitis circumscripta spinalis’ by William Gibson Spiller (1863–1940), J.H. Musser and Edward Martin (1859–1938) in 1903. A description of a similar case as ‘meningitis serosa spinalis’ was given by K. Mendel and Saul Adler in 1908. Victor Horsley (1857–1916) described it as ‘chronic spinal meningitis’ in 1909. War injuries were thought to be responsible by T. Mauss and H. Krugger in 1918. Chronic arthritis of the spine was incriminated by C.Vincent in 1930.J.D. French in 1946 pointed out a protrusion of an intervertebral disc as a cause. A presently established cause, spinal anesthesia, was identified by W.G. Haynes and F.A. Smith in 1942. Lipiodol and other contrast media were noted as a cause by P. Bucy and I.J. Spigel in 1943.
Spinal arachnoiditis leading to recurrent reversible myelopathy: A case report
Published in The Journal of Spinal Cord Medicine, 2022
Erol Jahja, Charles Sansur, Peter Howard Gorman
Arachnoiditis is a rare inflammatory condition leading to fibrosis and adhesions of the arachnoid membrane surrounding the spinal cord. It can be due to various conditions including infection, spinal interventions, subarachnoid hemorrhage, and trauma.1,2 The thickening of the membrane can lead to conglomeration of nerve roots within the thecal sac and clumped roots attaching to the meninges, presenting as soft tissue signaling in the thecal sac on magnetic resonance imaging (MRI).3 These changes can produce the characteristic symptoms of pain, spasms and sensorimotor changes. There have also been reports of urinary incontinence, frequency or urgency in 23% of chronic arachnoiditis cases.4 This condition usually causes permanent neurologic changes. Recurrent reversible cases of arachnoiditis have rarely been reported.5,6
Arachnoiditis ossificans associated with syringomyelia: a case report
Published in British Journal of Neurosurgery, 2019
Changbing Wang, Zhong Chen, Deyong Song, Tianhang Xuan
Calcification or ossification of the arachnoid membranes is a common phenomenon occurring during surgery and autopsy.1 However, spinal arachnoiditis ossificans is a rare chronic arachnoiditis, characteriszed by metaplastic ossification and/or calcification of the arachnoid membrane.2 The exact pathogenesis of arachnoiditis ossificans is still unknown. Nonetheless, a variety of causes such as previous trauma, surgery, subarachnoid haemorrhage or myelography leading to arachnoiditis are postulated.3 However, in many cases a specific precipitant cannot be identified, as in our case. According to Kaufman and Dunsmore’s theory,2 osseous metaplasia associated with chronic inflammation is probably the most likely cause, among mechanisms proposed for the development of the ossification. Because chronic fibroblastic proliferative change to the leptomeninges associated with the osseous metaplasia, were founded in all the cases they reviewed.2 Arachnoid cells have multipotential differentiation. When they are exposed to certain conditions, they undergo bony metaplasia and lead to the proliferation of osteoblasts, with increased activity and subsequent development of ossification.
Giant intradural extramedullary spinal ependymoma, a rare arachnoiditis-mimicking condition: case report and literature review
Published in British Journal of Neurosurgery, 2023
Nicolò Marchesini, Christian Soda, Umberto Maria Ricci, Giampietro Pinna, Franco Alessandrini, Claudio Ghimenton, Riccardo Bernasconi, Gaetano Paolino, Marco Teli
Spinal arachnoiditis constitutes an inflammation of the meninges, resulting in their thickening and scarring. The most common MR findings of arachnoiditis include central clumping of the nerve roots or their peripheral adhesion and tethering; sub-arachnoid space filled with soft tissue; pia and dura mater contrast enhancement. Syrinx and spinal cord hyperintensity can be associated. In most severe cases spinal arachnoiditis can appear as loculated arachnoid cystic cavities exerting mass effect on the spinal cord.45