Spinal Cord Injury in Older Adults
K. Rao Poduri in Geriatric Rehabilitation, 2017
Neurologic deterioration in patients with chronic SCI is commonly a result of syringomyelia (this term includes progressive cystic posttraumatic myelopathy, progressive noncystic, or myelomalacic myelopathies). It is the progressive enlargement of a cystic cavity originating at the site of injury that extends in either a cephalad or a caudal direction of the spinal cord. Its incidence ranges from <1% to 7%; however, its radiologic and autopsy incidence is higher. Arachnoid membrane scarring, which interferes with spinal fluid flow and spinal cord mobility, seems to be an underlying mechanism. It is more frequently seen in complete injuries, cervical and thoracic injuries, and older age at the onset of SCI. In 5% of patients with chronic SCI, it occurs within the first 10 years of injury.75
The Nervous System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
Inflammation of the spinal meninges is called spinal meningitis, Caused by either a viral or bacterial infection of the meninges, particularly the arachnoid and pia mater, the inflammation increases the amount of cerebrospinal fluid and changes its composition, resulting in the symptoms. The first sign is usually headache, fever, chills, and vomiting; neck rigidity, changes in reflexes, and back spasms are common. Diagnosis is usually made by examination of cerebrospinal fluid collected by lumbar puncture, and antibiotic therapy for the etiologic organism is primary in treatment.
Severe head injuries
Brian Sindelar, Julian E. Bailes in Sports-Related Concussion, 2017
A high school female soccer athlete headed the ball during a routine play in a competition, causing her to be “stunned” but not lose consciousness. After evaluation, she was removed from play and received an uncomplicated, prompt graded return to activity. Unfortunately, 6 weeks after the incident, the player developed an acute onset seizure with right-sided numbness. CT brain imaging demonstrated a large subdural hematoma resulting from a ruptured arachnoid cyst (Figure 4.17). An arachnoid cyst is filled with cerebrospinal fluid encased within a layer of arachnoid. This usually asymptomatic, benign lesion is commonly found incidentally but may cause subdural hematomas due to bridging veins being draped over the cyst wall. Due to the patient’s neurological deficits, a craniotomy was performed to remove the hematoma and fenestrate the cyst wall. Despite her full recovery, she did not return to soccer.
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
The pathogenesis of arachnoiditis is thought to be the result of a noxious insult to the pia-arachnoid matter causing inflammation followed by adhesion formation. The initial inflammation stage can lead to nerve root swelling, which can manifest into radicular symptoms. As this process continues, there is tethering of the nerve roots and spinal cord. With disorganized conglomeration, CSF flow can be disrupted, which can cause a mixture of complications, including ischemia, demyelination, cavitation and syringomyelia at the level of disrupted CSF flow.7 With adhesion and cyst formation, the disease process becomes more chronic as symptoms become persistent.5 In our case, the sudden waxing and waning nature of the symptoms could be attributed to temporary release of spinal fluid during lumbar puncture and sudden aggressive motion as would occur during a fall. Although the incidence is uncertain, prior reports have noted that inflammatory reactions such as arachnoiditis can result in intrathecal scarring, impeding subarachnoid CSF pathways.7 No animal models exist to support the pathophysiologic hypothesis, but a rat model linking post-traumatic arachnoiditis to increased CSF flow from perivascular spaces as the cause of syrinx expansion does exist and supports a relationship between trauma and CSF flow changes.8 Surgical lysis of adhesions in the subarachnoid space with expansile duraplasty is a well-established technique to treat impaired CSF flow around the spinal cord in patients with post-traumatic syringomyelia.9
Recrudescence of the syringomyelia after surgery of Chiari malformation type 1 with duraplasty
Published in British Journal of Neurosurgery, 2020
All patients underwent surgery in the prone position with their head fixed in a Mayfield head holder. A midline incision was made from the inion to C2 and dissection was performed to expose the occiput and C2. A 5 cm midline skin incision was centered 1 cm above the craniocervical junction. A small suboccipital craniectomy 2 cm in length and 2–3 cm wide was made. The rim of the foramen magnum was decompressed, then, the dura was opened in a ‘Y’ fashion and stitched to the periosteum of the occiput, a C1 laminectomy and duraplasty with artificial dura substitute (Case 1) or fascia lata were performed under the microscope. In all patients, the arachnoid was incised and resected, and cerebrospinal fluid (CSF) drained. Tonsillar sub-pial cauterization and resection of the outer and medial surface of tonsils without affecting intracranial vessels was done as described.5
Cerebrospinal fluid leaks secondary to dural tears: a review of etiology, clinical evaluation, and management
Published in International Journal of Neuroscience, 2021
Jason Gandhi, Andrew DiMatteo, Gunjan Joshi, Noel L. Smith, Sardar Ali Khan
The meninges are composed of three membrane structures that encapsulate the brain and spinal cord. The three membranes of the meninges from most superficial to deep are respectively the: dura, arachnoid, and pia mater. The dura mater is also referred to as the pachymeninx or “thick meninx”, while the pia and arachnoid mater collectively are referred to as the leptomeninx or “thin meninx” [5]. The dura itself is composed of three layers: the most superficial layer called the endosteal (i.e. periosteal), the meningeal layer, and the deepest layer called the dural border cell layer [6,7]. The dural border cell layer interacts with the arachnoid barrier cell layer and basement membrane of the arachnoid mater. It is in the arachnoid reticular layer and subarachnoid space that the CSF is contained. The depth of the subarachnoid space is variable depending on the relationship between the arachnoid and pia mater [7].
Related Knowledge Centers
- Cerebral Hemisphere
- Meninges
- Neural Crest
- Pia Mater
- Spinal Cord
- Dura Mater
- Brain
- Membrane
- Sulcus
- Longitudinal Fissure