Post-traumatic cerebral arachnoiditis of the brain is chronic inflammation which is associated with traumatic brain injury. Arachnoiditis mainly spreads through the arachnoid and soft membranes in the brain. The disease is characterized by slow development, usually 2-6 years.

In many cases, the development of the disease is associated with focal crushes and bruises, violations of the integrity of the soft membranes of the brain, and significant accumulations of tissue decay products and blood in the subarachnoid cavity. In the pathogenesis of the disease important role has autoallergies to the body's brain and the formation of antibodies to disrupted antigens.

A thickening of the arachnoid membrane is detected, which acquires a grayish-white tint. Connections and adhesions are formed between the soft and arachnoid membranes, dysfunction in the circulation of cerebrospinal fluid is observed with the appearance of different-sized carpal extensions. This leads to enlargement of the ventricles of the brain.

According to the ratio of adhesions and cysts, adhesive-cystic, cystic, adhesive post-traumatic cerebral arachnoiditis of the brain is distinguished. In many cases, its development occurs during the intermediate stage of injury. It is determined by a remitting course, when exacerbation of the disease changes to remission of varying duration.

With the adhesive form of arachnoiditis, adhesions form. With cystic arachnoiditis, cavities of different sizes with colorless or yellowish liquid are formed, each of which contains a cyst. Cysts can be single or numerous. All neoplasms are the result of impaired cerebrospinal fluid dynamics.

Symptoms of the disease

For a type of disease such as cerebral arachnoiditis, symptoms are revealed by destruction of the functions of the parietal, temporal or frontal lobes. Signs are characterized increased irritability, vegetative-vascular instability, with severe headaches, vomiting and relapses of epilepsy.

Cerebral arachnoiditis the symptoms of which are combined with correction and reduction of visual edges, manifested by central and paracentral defects, dulling of the optic nerves. Psycho-emotional disorders, rapid fatigue and intolerance to harsh stimuli are possible.

Diagnostics

Before treatment for cerebral arachnoiditis begins, diagnostic tests are performed. In order to determine accurate diagnosis, it is necessary to collect all the information about the symptoms and time of manifestation, severity. Visual acuity and fundus examination are performed. An examination is carried out by a psychiatrist to determine symptoms.

Using pneumoencephalography, discontinuity of subarachnoid fissures with the presence of cystic enlargements is revealed. Computer and magnetic resonance imaging of the head can also detect arachnoiditis and the stage of its development, the presence of hydrocephalus, adhesions, and cysts.

Sometimes doctors use lumbar puncture, which involves inserting a puncture needle into the subarachnoid cavity and removing cerebrospinal fluid.

Treatments

Treatment of cerebral arachnoiditis is carried out in individually in accordance with the signs and localization of the process. In this case, the patient is prescribed:

• Medicines with nootropic effects (aminalon, nootropil, ceraxon, encephabol, etc.);
• Substances that affect tissue metabolism (enzymes, amino acids);
• Vasotropic drugs (Cavinton, etc.).

The doctor may prescribe anticonvulsant and resorption therapy with pyrogenal and lidase. Immunocorrectors can be used. For severe headaches, analgesic drugs are prescribed. For the treatment of mental disorders, tranquilizers and antidepressants are used.

For occlusive forms of the disease, with the formation of large cysts, surgical intervention is provided. After surgery, patients become disabled.

With timely treatment, recovery is possible. Postcranial arachnoiditis is more difficult to treat, especially when cerebral hydrocele appears.

Patients are prohibited from staying in noisy rooms, lifting heavy objects, or driving. public transport. It is allowed to carry out simple work outside the boundaries of industrial facilities, with a short stay at height or on the street.

Preventive actions

• Timely treatment of traumatic or infectious diseases;
• Visit to an ophthalmologist or ENT specialist. If you have mental difficulties, you should consult a psychiatrist;
• Definition of disease in closed form of traumatic brain injury.

Arachnoiditis can become a serious complication after inflammatory and infectious diseases of the sinuses and middle ear. With this disease, the arachnoid membranes of the brain and spinal cord are involved in the pathological process; the symptoms of the disease depend on the spread and localization of the inflammatory reaction.

Arachnoiditis - the main causes and clinical picture of the disease

Arachnoiditis in most sick people is detected several days or weeks after suffering from influenza, sore throat, acute pneumonia, or sinusitis. Often the cause of the disease is syphilis, brucellosis, and inflammation of the middle ear. Arachnoiditis occurs and after cranial brain injuries when affected by inflammatory changes in the lining of the brain. In fairly rare cases, cerebral arachnoiditis develops with endocrine pathologies and in cases of deep metabolic disorders.

The disease causes thickening of the arachnoid membranes, resulting in adhesions between the hard, soft and arachnoid membranes of the brain. The adhesive process forms a cyst filled with cerebrospinal fluid. Gradually, this cyst becomes denser and increases in size, which causes compression of different parts of the brain. Symptoms of arachnoiditis depend on where the cyst grows. Arachnoiditis can occur suddenly and then characteristic clinical picture allows the doctor to quickly make a diagnosis. In some cases, arachnoiditis begins to manifest gradually and therefore its treatment begins already with a pronounced pathological process.

Except characteristic features there are lesions in different parts of the brain and general symptoms, indicating arachnoiditis, they usually include:

• Strong headache, increasing in the morning, when changing body position, due to changes in weather conditions.
• At the peak of pain, nausea and vomiting may occur.
• Patients often complain of dizziness and lightheadedness.
• Arachnoiditis causes the development of depression, anxiety, and disrupts sleep and performance.
• Skin sensitivity increases or, on the contrary, becomes dull.
• Over time, epilepsy attacks may occur.

The risk of damage to the membranes of the brain increases in people with weakened immune systems who have bad habits doing heavy physical labor. Arachnoiditis can be acute or chronic; treatment directly depends on the stage of development of the inflammatory process.

Classification of arachnoiditis

Arachnoiditis is usually classified by location; characteristic symptoms allow a correct diagnosis to be made even before full diagnostics begin symptomatic treatment.

Treatment requires preliminary diagnosis. The neurologist prescribes a skull x-ray, ultrasound, and computed tomography. A complete neurological examination is performed.

Arachnoiditis - the main treatment

Treatment involves identifying the underlying cause.

• When otitis, sinusitis and other infectious diseases are detected, treatment must be carried out using antibiotics - Methicillin, Ampiox, Penicillin in average therapeutic doses.
• Reducing intracranial pressure is achieved through the use of diuretics - Furosemide, Lasix, Mannitol.
• Treatment is also carried out to restore the structure of damaged membranes. For this purpose, biogenic stimulants are prescribed - Aloe, vitreous.
• It is necessary to achieve resorption of adhesions - Lidaza and Pyrogenal are prescribed.
• For seizure symptoms, treatment is carried out with anticonvulsant drugs.
• Depending on the identified symptoms, other symptomatic treatment is also used.

Arachnoiditis detected in the acute stage can be cured quite successfully. But at the same time, the disease can develop into chronic form with exacerbation periods of different duration and symptoms. The first course of therapy is usually long and can last up to six months; after all the characteristic signs of the disease have disappeared, arachnoiditis can be treated simultaneously with medications and folk remedies.

Arachnoiditis - treatment with folk remedies

Treatment of arachnoiditis with folk remedies can improve blood circulation in different parts of the brain and relieve inflammation with painful attacks.

Arachnoiditis must be treated with both folk remedies and medications under the full supervision of a neurologist. Periodic examination allows you to understand how the treatment of the disease is progressing.

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 it, and doctors may miss warning signs of complications.

Definition

Arachnoiditis is an inflammation of the arachnoid membrane of the spinal cord or brain. This division is arbitrary, since isolated forms do not occur in clinical practice. This is device related vascular system. The infection spreads from the dura or pia mater, so arachnoiditis can be compared to serous meningitis.

The term “arachnoiditis of the brain” is gradually turning into atavism, since pathomorphologically and clinically it is difficult to separate inflammation of the arachnoid membrane. Doctors are inclined to believe that all manifestations of irritation of the membrane will be called meningitis.

History and etiology

Tarasenkov first introduced the term “arachnoiditis” into medicine in his dissertation in the mid-nineteenth century. A more detailed description of this disease was provided by neurologist Benninghaus. 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 salt intoxication heavy metals and injuries. In addition, pathology may appear against the background of an oncological process and encephalitis.

The most common cause of arachnoiditis is chronic purulent otitis media and its complications: labyrinthitis, petrositis and sinus thrombosis. Therefore, it is localized in the posterior or middle cranial fossa.

The disease is divided into acute, subacute or chronic. And according to the prevalence of the process, diffuse and limited arachnoiditis are distinguished. As a rule, they are combined or follow each other in the clinical picture.

Symptoms

How does a disease such as cerebral arachnoiditis manifest itself? Symptoms are a combination of general cerebral and local disorders. The former are associated with an increase in cerebrospinal fluid pressure, and the latter indicate the location of the source of inflammation. Depending on which symptom complex predominates, the manifestations of the disease may differ.

The most common complaint in the clinic is headache, which is accompanied by nausea and vomiting, which does not bring relief. The pain can be focused in one place and intensify with movement, mental or physical stress. In addition, there is dizziness (even in a lying position), irritability, severe weakness, combined with sleep disturbances. Photophobia and intolerance may occur loud sounds, muscle rigidity.

But this is not the only way brain arachnoiditis manifests itself. Signs of focal disorders depend on location pathological process. If the focus is on the convex surface of the brain, then, most likely, the patient will experience loss of function, episodes epileptic seizures. The location of inflamed tissue on the undersurface of the brain causes cranial nerve disorders. These are symptoms such as decreased vision or loss of its fields, neuritis of the facial and trigeminal nerves, and decreased sense of smell. They can be combined with manifestations of autonomic damage nervous system (increased sweating, blue skin, thirst, frequent urination, increased blood glucose).

Brain arachnoiditis can also occur in the system of formation and circulation of cerebrospinal fluid. Symptoms of this condition appear in sharp increase temperature, vomiting, pain in the neck and back of the head, nystagmus and increased tendon reflexes. In such cases, it is imperative to differentiate pathological symptoms from the development of tumors of the posterior cranial fossa. But lumbar puncture can be performed only if there is no congestion in the fundus.

Cerebral arachnoiditis

If the inflammatory focus is located on a convex (convexital) surface, then it is called “cerebral arachnoiditis of the brain.” Its symptoms include manifestations of damage to the membranes of the brain and impaired outflow of fluid. The most common first sign is severe headaches. Due to tissue swelling, normal circulation of cerebrospinal fluid will be difficult, which will lead to its accumulation and development intracranial hypertension.

Treatment of cerebral arachnoiditis is designed for long-term course therapy with agents that resolve scar tissue. In addition, it is necessary to normalize intracranial pressure, improve the outflow of cerebrospinal fluid, stimulate cerebral circulation and oxygen delivery to nervous tissue.

In general, it is necessary to restore everything that was damaged by brain arachnoiditis. Treatment with medications, for example biogenic stimulants, Lidase, Pyrogenal, courses of fifteen injections every six months, gives positive results even in difficult cases diseases. Diuretics and decongestants are used to reduce blood pressure. Antiepileptic drugs are excellent for relieving seizures.

As a preventive measure, general strengthening therapy is carried out; if there are additional problems,

Prognosis and prevention

Timely treatment of cerebral arachnoiditis usually results in recovery. The only danger can be inflammatory process, which is located in the posterior cranial fossa and is accompanied by blocking of the openings of the ventricles of the brain. The prognosis is worsened by frequent relapses of the disease or its progressive course against the background of hypertensive crises, epileptiform seizures, as well as localization of inflammation in the projection of the optic chiasm.

What needs to be done to prevent cerebral arachnoiditis? Its consequences are quite serious, so you should pay attention to your health and contact medical institution for help. It is necessary to prevent sinusitis, otitis and sinusitis, get vaccinated according to the calendar, and most importantly, treat all infectious diseases on time and completely. Because they are the ones who lead to the development of arachnoiditis.

Work ability

The disease arachnoiditis of the brain can cause disability in a person. Even against the background of relative clinical well-being, the consequences of the infection remain for life.

The third disability group is assigned to patients who are able to care for themselves and also perform light work. They are recommended to change their profession and lead correct image life as much as possible.

The patient receives disability of the second group if, after treatment, he still has episodes of epileptic seizures and decreased visual acuity. They can no longer perform their professional duties, but are quite capable of caring for themselves. Disabled people of the first group are considered to be patients who have completely lost their vision as a result of illness.

Patients with the third group are contraindicated from working at heights, near open flames and moving machinery, or in transport. It is recommended to exclude difficult meteorological conditions associated with changes atmospheric pressure, work in noisy, gas-filled rooms, work associated with vibration.

After the doctor has diagnosed “cerebral arachnoiditis,” the symptoms, treatment and rehabilitation of patients are carefully studied by specialists of a medical and social expert commission. Any, even the most insignificant detail can influence the decision to assign the status of a disabled person, since this is followed by certain benefits.

Arachnoiditis: causes, forms, signs, treatment, prognosis

Arachnoiditis is inflammation in the arachnoid membrane of the brain or spinal cord against the backdrop of a viral bacterial infection, an autoimmune or allergic process that is more common among young people.

The disease was first described at the end of the 19th century, but discussions continue to this day. Many people with chronic headaches and signs of hypertension syndrome are repeatedly treated in neurological hospitals, but not pathogenetic therapy doesn't bring desired result, only briefly improving the patient's condition.

Meanwhile, arachnoiditis can cause disability, and in severe cases, patients need to develop disability groups, Therefore, the problem of a competent approach to this disease remains extremely relevant.

The brain is surrounded by three membranes: hard, soft and arachnoid. The arachnoid is located under the dura mater and covers the outside of the brain, connecting with the vascular, the elements of which penetrate between the convolutions. Since the arachnoid membrane is closely connected with the soft membrane and does not have its own blood supply, the concept of arachnoiditis is criticized today, and inflammation of the arachnoid membrane is considered within the framework of meningitis.

Until recently, numerous studies were scattered, based on observations of many patients, analysis of various changes in the meninges, data from additional examinations, but clarity emerged with the use of neuroimaging techniques.

Today, most experts agree that the basis of arachnoiditis is a combined inflammation of the arachnoid and pia mater of the brain, the development of adhesions and cysts with impaired movement of cerebrospinal fluid, hypertension syndrome, damage nerve structures brain, cranial nerves or spinal roots.

In the case of autoimmune diseases, isolated production of antibodies against elements of the arachnoid membrane is possible, then the inflammatory process can be limited to one membrane and they speak of true arachnoiditis. Inflammation after injuries or infections is referred to as residual states.

Among patients with arachnoiditis, young people (under 40 years of age) and children predominate; pathologies may develop in weakened individuals, patients with alcoholism, and metabolic disorders. There is a high prevalence of pathology among men, in whom arachnoiditis is diagnosed up to two times more often than in women.

Why does arachnoiditis develop?

As you know, most inflammatory processes occur due to the fault of microbes, but “internal” causes are also possible, when the body itself contributes to damage to its own tissues. In some cases, allergic reactions play a leading role.

The causes of arachnoiditis can be:

• Viral diseases - influenza, chickenpox, cytomegalovirus, measles;
• Past meningitis, meningoencephalitis;
• Pathology of ENT organs – otitis media, tonsillitis, sinusitis.;
• Transferred - brain contusion, hemorrhages under the arachnoid membrane;

It is known that arachnoiditis often affects weakened patients, people working in harsh climatic conditions, where hypothermia can be a provoking factor for inflammation. Intoxication with arsenic, lead, alcohol, prolonged fatigue, vitamin deficiencies can also be a predisposing background.

More than half of cases of arachnoiditis are associated with viral infections, when the disease becomes generalized, involving the meninges.

About a third are associated with injuries to the brain or spinal cord - post-traumatic arachnoiditis. Highest value have a brain contusion and hemorrhages under its membranes; the risk increases with repeated damage to the nervous system.

Pathology of the ENT organs plays a significant role in the genesis of arachnoiditis. This is no coincidence, because the structures of the ear, paranasal sinuses, and tonsils of the pharynx become inflamed quite often in all people age groups, and the close proximity of the brain and its membranes creates the preconditions for infection to penetrate into the cranial cavity. Long-term, untreated tonsillitis, otitis, and periodontal pathology can cause arachnoiditis.

Despite sufficient diagnostic capabilities, it is still It happens that the cause of arachnoiditis remains unclear, and such patients account for about 10-15%. If after a thorough examination it is not possible to find the cause of inflammation in the membranes of the brain, then the process will be called idiopathic.

How does arachnoiditis develop and what are its forms?

So, it has been established that the arachnoid membrane cannot be damaged in isolation. Due to its tight fit to the choroid, the latter is somehow involved in inflammation, and we are usually talking about arachnomeningitis (meningitis). There are different types of this disease:

1. True arachnoiditis;
2. Residual inflammatory process.

True arachnoiditis is spoken of when the cause is autoimmunization or allergy. Inflammation occurs with the formation of antibodies to membrane structures, productive inflammatory reaction, the membranes thicken, become cloudy, and adhesions form between them, preventing normal circulation cerebrospinal fluid. Usually the process is widespread, possibly involving the upper cellular layer of the cerebral cortex, choroid plexus, and ependymal lining of the cerebral ventricles.

It is believed that true arachnoiditis is extremely rare pathology, occurring in no more than 3-5% of cases of damage to the meninges. Its higher frequency in diagnoses is usually the result of overdiagnosis.

Residual arachnoiditis follows neuroinfection or trauma, therefore, its main component will be the adhesive process of the intershell space, the formation of dense adhesions and, as a consequence, cysts filled with cerebrospinal fluid.

Based on location, cerebral arachnoiditis is distinguished, when inflammation occurs in the brain, and arachnoiditis of the spinal cord, which is also equipped with soft and arachnoid membranes. Cerebral arachnoiditis gives the whole gamut brain symptoms, and the spinal one occurs with signs of damage to the motor and sensory roots.

spinal cord arachnoiditis

The predominant change in the subarachnoid space determines the allocation:

• Cystic;
• Adhesive;
• Mixed arachnoiditis.

The cystic process is accompanied by the formation of cavities (cysts) due to fibrous growths between the membranes. The cysts are filled with cerebrospinal fluid. In adhesive arachnoiditis, fibrinous inflammatory effusion leads to the appearance of loose adhesions that obstruct the flow of cerebrospinal fluid. In some cases, a combination of adhesive and cystic components occurs, then they speak of mixed arachnoiditis.

According to the predominant localization, arachnoiditis is:

1. Diffuse;
2. Limited;
3. Basal;
4. Convexital;
5. Posterior cranial fossa.

Limited arachnoiditis is extremely rare, since it does not have boundaries of the brain membrane as such, and the inflammation becomes widespread. If symptoms of local damage to brain structures predominate, then they speak of limited arachnoiditis of a specific localization.

Convexital arachnoiditis predominates in that part of the membranes that covers the outside of the brain. It occurs more easily than the basal one, which occurs in the base of the brain and involves the cranial nerves, table of the brain, cerebellum, and optic chiasm.

Manifestations of arachnoiditis

Signs of arachnoiditis do not appear acutely. The disease develops after a fairly long period of time: from several months to a year after acute respiratory viral infection, up to two years with cranial injuries. The course is continuously progressive, with alternating phases of exacerbation and remission.

Beginning subacutely, the pathology takes chronic nature. The onset may be manifested by symptoms of asthenia, and the patient will complain of weakness, severe fatigue, headaches, low emotional background and irritability. As the inflammatory process increases, general cerebral and focal symptoms appear.

Since arachnoiditis causes the appearance of adhesions and adhesions between the membranes of the brain, it is not possible to avoid disturbances in liquorodynamics. Cerebrospinal fluid accumulates in cysts in the subarachnoid space, leading to expansion of the brain cavities and their obstruction. Impaired outflow of cerebrospinal fluid is combined in some cases with a slowdown in the reabsorption of excess fluid. In parallel with the increase in the volume of cerebrospinal fluid, the pressure inside the skull increases, so hypertension syndrome can be considered one of the key manifestations of arachnoiditis.

General cerebral symptoms associated with, which inevitably accompanies the adhesive process, when the outflow and reverse suction cerebrospinal fluid, which is accompanied by:

• Severe headaches, mainly in the early morning;
• Nausea and vomiting;
• Soreness in the eyeballs.

Symptoms often include tinnitus, dizziness, vegetative phenomena in the form of sweating, cyanosis of the fingertips, thirst, and possibly oversensitivity to bright lights and loud sounds.

manifestations of arachnoiditis

Periodic fluctuations in intracranial pressure manifest liquorodynamic crises, when sudden high hypertension leads to intense pain in the head with nausea and vomiting. This condition can recur once every couple of months if severe and last up to two days.

Focal neurological symptoms caused by involvement of brain structures and differs with different localization of inflammation. The most common manifestation is seizures, which can be generalized.

Arachnoiditis of the brain is accompanied by damage to the convexital surfaces of the membranes, the base of the brain, and formations of the posterior cranial fossa. Focal neurological phenomena in convexital arachnoiditis include:

• Seizures;
• Paresis and paralysis;
• Disorders of the sensitive area;

Localization of inflammation in the area of ​​the optic chiasm, at the base of the brain, occurs with vision impairment up to its complete loss, loss of its fields, and the process is bilateral in nature. The nearby pituitary gland may also be damaged, and then symptoms of endocrine disorders will appear in the clinic.

If the front parts of the brain are damaged, memory and attention may decrease, psychical deviations, convulsive syndrome, disturbance of the emotional sphere.

Arachnoiditis of the posterior cranial fossa suggests serious condition. Symptoms boil down to:

• Damage to cranial nerves (hearing disorder, neuralgia trigeminal nerve);
• Cerebellar symptoms – pathology of balance, impaired motor skills and coordination;
• Visual impairment;
• Severe hypertension syndrome.

The limited space of the posterior part of the cranial cavity, narrow liquor pathways predispose to a closed form, a sharp increase in intracranial pressure with the appearance of severe headaches, nausea, and vomiting. The danger of this localization of inflammation is not only the involvement of cranial nerves, but also the likelihood of herniation of nerve structures into the foramen magnum, and this can cost the patient his life.

In addition to brain damage, spinal cord arachnoiditis is possible. Inflammation most often occurs in the thoracic, lumbar or sacral regions, appears radicular symptoms with pain and changes in sensation and movement. The clinical picture of spinal cord arachnoiditis is very similar to a neoplasm compressing from outside nerve roots. The pathology is chronic, accompanied by a cystic and adhesive process.

Principles of diagnosis and therapy

Treatment of arachnoiditis is always carried out in a hospital setting and can be medicinal or surgical. Persons with suspected inflammation of the arachnoid membrane are hospitalized in neurological departments, where to establish a diagnosis it is necessary to conduct a thorough examination, including:

1. X-ray of the skull:
2. Echo and electroencephalography;
3. Consultation with an ophthalmologist and ENT doctor;
4. CT and MRI of the brain;
5. Lumbar puncture to clarify intracranial pressure figures, collection of cerebrospinal fluid for analysis of protein and cellular composition.

magnetic resonance imaging (MRI) of the brain

Drug therapy is carried out over a long period of time, in courses, taking into account the etiological factor and includes:

• Antibacterial or antiviral drugs;
• Antihistamines (pipolfen, diphenhydramine, suprastin, claritin, etc.);
• Absorbable treatment aimed against adhesions in the interthecal space (lidaza, rumalon, pyrogenal);
• Diuretics for hypertension syndrome (mannitol, diacarb, furosemide);
• Anticonvulsant therapy (carbamazepine, finlepsin);
• Anti-inflammatory drugs - glucocorticoids (especially for allergic and autoimmune inflammation);
• Neuroprotective treatment (mildronate, cerebrolysin, nootropil, B vitamins).

Since the disease lasts a long time, it is accompanied by manifestations of asthenia and emotional disorders, a number of patients require the prescription of antidepressants, sedatives, tranquilizers.

In all cases of arachnoiditis, other foci of bacterial or viral infection are searched for and treated, since they can be a source of repeated inflammation of the meninges. In addition to antibiotics, antiviral agents general strengthening measures, taking multivitamin complexes are indicated, good nutrition and adequate drinking regime.

With severe hypertension syndrome, signs of increased pressure inside the skull cannot always be relieved with drug treatment, and then doctors are forced to resort to surgical interventions. Among them, the most common are shunt operations that ensure the outflow of cerebrospinal fluid from the skull, as well as operations to cut adhesions and adhesions, and remove cerebrospinal fluid cysts, which are performed in neurosurgical departments.

The prognosis for arachnoiditis is favorable for life, but the disease can lead to disability. Convulsive seizures, decreased vision, and frequent relapses of arachnoiditis can make it impossible for the patient to perform the usual work duties and become a reason for establishing a disability group. Complete blindness forces assignment to the first group, and the patient needs care and assistance in everyday life.

If a patient with arachnoiditis remains active at work, then types of work associated with climbing to heights, driving vehicles, and the proximity of fire and moving mechanisms will be contraindicated for him. Excluded are industries where harmful factors include vibration, loud noise, low temperatures, severe climatic conditions, the effects of toxins.

To prevent inflammatory processes in the membranes of the brain, all existing foci of infection should be promptly treated, especially in the ear and paranasal sinuses, and traumatic brain injuries should be avoided. If you experience prolonged headaches after infections or brain injuries, you should see a doctor for a thorough examination and to rule out arachnoiditis.

Arachnoiditis is an inflammation of the lining of the brain. During illness, the spaces that serve for the outflow of cerebrospinal fluid stick together. As a result, it stops circulating and begins to accumulate in the cranial cavity. If the manifestations of the disease are left unattended, this usually leads to hydrocephalus. But it can be treated only after it has been carried out treatment of arachnoiditis as the main disease.

Symptoms of arachnoiditis

Manifestations of the disease:

Headache. It haunts the patient both day and night and only intensifies with each one. Intracranial pressure remains constant. Even while concentrating, headaches appear.

Nervous exhaustion. Fatigue, depression, fear, apathy and aggression appear. Sleep disturbances appear.

Vegetative-vascular instability. Arachnoiditis causes sensitivity to changing weather conditions. Dizziness appears, then fainting and changes in blood pressure.

Sensitivity is impaired. Sudden numbness of parts of the body or vice versa, increased sensitivity to pain.

Symptomatic epilepsy. Symptoms include loss of consciousness, seizures, and asymptomatic epilepsy.

Diagnostic symptoms of arachnoiditis

Diagnosis of the disease is carried out on the basis of a comprehensive and detailed examination of the patient. Of primary importance are the symptoms of arachnoiditis, the severity of neurological symptoms, examination of vision, fundus, symptoms of intracranial hypertension, and blood pressure levels. Important laboratory research blood and cerebrospinal fluid.

When diagnosing, it is most rational to use encephalography, rheoencephalography, pneumoencephalography, echoencephalography, craniography and radionuclide studies.

When using the method of boulevard angioscopy, it is possible to detect vascular spasm, as well as depletion of the capillary network, expansion of the venous network, up to venules, and an increase in the number of functioning capillaries.

Using computed tomography in diagnosing the disease arachnoiditis, it is possible to determine the size of the ventricular and cistern system; if there is a blockage of the cerebrospinal fluid pathways, its level can be determined.

If there is a process at the base of the brain, in the chiasm zone A characteristic symptom of the disease is progressive visual impairment, up to blindness. The fundus reveals a congestive nipple, atrophy optic nerve. Characteristic is a narrowing of the visual fields, oculomotor disorders: ptosis, diplopia, strabismus, anosmia.

When localizing the process in the region of the posterior cranial fossa arachnoiditis causes damage to the meninges in the area of ​​the lateral or large tank, in the craniospinal region with possible violation circulation of cerebrospinal fluid. This is a common and severe form cerebral form diseases. Clinical symptoms arachnoiditis may resemble the symptoms of a cerebellar tumor, but a more rapid increase in these symptoms is characteristic. General cerebral symptoms are more pronounced than focal ones. A characteristic symptom of arachnoiditis is headache, localized in the occipital region and radiating to the eyeballs And back surface neck. As the disease progresses, attacks of diffuse headaches occur, accompanied by nausea and vomiting. Meningeal symptoms are moderately pronounced. Mental disturbances are possible: from mild stupor to confusion. The manifestation of focal symptoms depends on the localization of the process. Possible cerebellar symptoms arachnoiditis, damage to the V, VI, VII, VIII pairs of cranial nerves, attachment pyramidal insufficiency. Changes in the fundus are a manifestation of intracranial hypertension. Expressiveness visual impairment depends on the duration of the disease and the degree of definition of intracranial hypertension.

Possible early appearance of congested nipples.

When spreading the process in the area of ​​the vermis and hemispheres Mild static disorders and damage to the cranial nerves are noted.

When localizing the process in the area of ​​the cerebellopontine angle characterized by focal and mild cerebral symptoms. Damage to the VIII pair of cranial nerves occurs (clinically: tinnitus, dizziness, ataxia, hearing loss, nystagmus). Damage to the VII and VI pairs of cranial nerves is possible. When the V pair is damaged, a decrease in the sensitivity and motor function of this nerve is characteristic, and possibly even a disappearance. It has been clinically noted that arachnoiditis causes a decrease in the corneal reflex on the affected side, a change in the sensitivity of the facial skin and oral mucosa. Attacks of trigeminal neuralgia are possible. Cerebellar disorders are characterized by one-sidedness. Manifestations of pyramidal symptoms are tendon asymmetry and the appearance of pathological reflexes.

Protein-cell dissociation is determined in the cerebrospinal fluid. The ventriculogram shows dilation of the ventricles.

Differential symptoms of arachnoiditis

When conducting differential diagnosis diseases with a tumor, the distinctive symptoms of arachnoiditis are:

duration of the process without a pronounced increase in conduction disorders;

phenomena of remote radicular irritation at a considerable distance from the affected segment;

less pronounced changes in the cerebrospinal fluid in comparison with tumor processes.

Symptoms of arachnoiditis different stages

There are three stages of the disease:

acute stage manifests itself acute neuritis optic nerves, in which one can note pronounced hyperemia and swelling of the discs, a sharp expansion and tortuosity of the veins, hemorrhagic signs;

subacute stage, in which the phenomena of edema, hyperemia and hemorrhagic manifestations are less pronounced, but more pronounced dilation and tortuosity of the veins appear;

chronic stage, at which it is possible to determine varying degrees blanching of the optic discs.

Symptoms of different types of arachnoiditis

We suggest you familiarize yourself with the symptoms of the disease depending on its type.

Cerebral arachnoiditis. Localized in frontal lobes, in the area of ​​the base of the brain. At chronic course there is a disruption in the normal circulation of cerebrospinal fluid, internal hydrocephalus.

Traumatic arachnoiditis. The process is localized in the area of ​​the transverse, posterior tank. Scar changes in this area lead to hydrocephalus.

Spinal arachnoiditis. Localized in the spinal cord.

The prevalence of arachnoiditis among the population is characteristic. More often registered among women.

Common signs for all arachnoiditis are:

• the occurrence of arachnoiditis 10–12 days after the infectious disease;
• presence of headaches with a feeling of fullness and pressure on the eyes;
• sleep disturbance;
• decreased performance;
• blurred vision;
• presence of astheno-neurotic syndrome,
• hypochondria.

Symptoms of convexital type arachnoiditis

Features of the clinical manifestations of the disease are determined by the localization of the process.

With the development of convexital arachnoiditis, the main clinical manifestation are functional disorders cortical layer in the region of the frontal, parietal and temporal lobes, while the region of the central gyri is also involved in the process.

Most characteristic symptoms arachnoiditis are:

general weakness,

fast fatiguability,

increased sweating,

bad memory

dizziness,

constant or paroxysmal headache,

nausea or vomiting.

In addition, there may be increased meteosensitivity, various sleep disorders, unstable arterial pressure. The most typical localization of headaches is the frontal, parietal or occipital regions, and in the area of ​​greatest pain there is always pain when percussing the head. Focal symptoms were noted: anisoreflexia, pathological reflexes, decreased abdominal reflexes, central paresis of the VI, XII pairs of cranial nerves, pain in the exit points of the trigeminal nerve. In the fundus, arachnoiditis causes dilation of the retinal veins and pallor of the optic discs. Local or general epileptic seizures are characteristic.

Symptoms of basal type arachnoiditis

Basal arachnoiditis is divided into:

• optochiasmal arachnoiditis of the posterior cranial fossa
• and cerebellopontine angle.

With opticochiasmatic arachnoiditis, the process is localized in the area of ​​the optic chiasm, and adhesions or cysts form. First of all, with the development of this pathology, visual acuity begins to decrease, and the visual fields of one or both eyes change. At the first stage, the fields of vision begin to narrow to green and red colors. Against the backdrop of the ongoing process of vision loss, patients begin to complain of headaches, and changes in function occur. oculomotor nerves. Further, violations of autonomic regulation are identified, which clinically manifests itself in the form of sleep disturbances, water-electrolyte disturbances or carbohydrate metabolism. When diagnosing arachnoiditis, the ophthalmologist may note atrophy of the optic nerve or even congestion of the optic nerve nipple in the fundus.

Symptoms of diffuse cerebral arachnoiditis

Available diffuse cerebral arachnoiditis. Clinically, there are no clear pathognomonic symptoms. General cerebral phenomena associated with impaired cerebrospinal fluid dynamics against the background of changes in the drainage function of the arachnoid membrane are determined. General cerebral symptoms clinically manifest themselves in the same way as with convexital arachnoiditis. Sometimes there may be signs of damage to individual cranial nerves, as well as pyramidal symptoms.

With diffuse cerebral arachnoiditis with instrumental methods studies can reveal uneven expansion of the ventricles. In this case, various syndromes may predominate:

hypothalamic,

temporal,

midbrain,

rhomboid fossa

and cortical, determined by the localization of the process.

Symptoms of spinal arachnoiditis

Spinal arachnoiditis is characterized by damage to the lumbosacral, thoracic spinal column. There are three types of spinal arachnoiditis

• sticky,
• cystic,
• adhesive-cystic.

The inflammatory process can be diffuse and limited, single-focal and diffuse.

For diffuse spinal Arachnoiditis is characterized by a variety of manifestations of the clinical picture, consisting of symptoms of damage to the spinal cord, its membranes and roots at various levels. Possible sensory, motor and pelvic disorders, which may increase depending on the progression of the disease. Meningeal syndrome in this case is manifested by Kernig's symptom and lower Brudzinski's symptom. The disease often occurs against the background of normal or low-grade fever bodies. There are no changes in the blood with arachnoiditis. Sometimes a moderate increase in the white blood cell count is possible. Protein-cell dissociation was noted in the cerebrospinal fluid; the amount of protein increased slightly.

For limited adhesive spinal Arachnoiditis is clinically most characterized by the manifestation of damage to the roots, which creates a clinical picture of radiculitis and is manifested by caudit, sciatica, and intercostal neuralgia. A long course of the disease is possible.

Cystic spinal arachnoiditis clinically resembles a spinal cord tumor. Characterized by radicular pain and parasthesia, dysfunction of the pelvic organs, and the appearance of conduction disorders of movement and sensitivity. Spinal compression syndrome gradually develops, manifesting itself:

high blood pressure in the liquor,

xanthochromia,

protein-cell dissociation.

Treatment of arachnoiditis

Treatment of arachnoiditis can be conservative or surgical. Treatment of arachnoiditis is determined clinical form diseases. Arachnoiditis of the posterior cranial fossa and spinal cord, convex surface of the cerebral hemispheres, optochiasmatic region, cysts are treated surgically. Shunting is being used for hydrocephalus. in other cases, drug treatment for arachnoiditis is used.

Drug treatment of arachnoiditis

Treatment of arachnoiditis takes long time and is conducted in courses. In therapy, dehydration, anti-inflammatory, absorbent, and hyposensitizing agents are used. If an acute period of arachnoiditis has begun, then doctors prescribe antibacterial drugs. The stages of drug treatment for arachnoiditis are described in more detail below.

treatment of arachnoiditis antibacterial therapy, taking into account the infectious genesis of arachnoiditis (drugs that pass through the blood-brain barrier are recommended: 3rd generation cephalosporins, semisynthetic penicillins, Kanamycin). Antibiotics are administered not only in the usual way, but also by the endolymphatic method to the area of ​​the posterior cervical lymph nodes, intracarotid infusion is possible. Effective treatment arachnoiditis using intramuscular injections of Bioquinol or Humisol;

in acute inflammatory processes (especially against the background of influenza), short courses of corticosteroids and desensitizing therapy are recommended for the treatment of arachnoiditis. The most commonly used drugs for this purpose are Prednisolone 3-10 mg/kg/day, Dexamethasone 1-2 mg/kg/day. You can use Histoglobin, which, along with a decongestant, desensitizing effect, also has general strengthening effect and is effective for allergic and infectious-allergic nature of the disease;

for intracranial hypertension in the treatment of arachnoiditis, it is recommended to administer a 25% solution of magnesium sulfate, dehydrating agents: Lasix, Triampur, Brinaldix, Veroshpiron, Hypothiazide, Diacarb. Taking diuretic drugs for the treatment of arachnoiditis is carried out taking into account contraindications and side effects drugs;

used in the treatment of arachnoiditis intravenous administration potassium iodide, iodine intake;

air is blown into the subarachnoid space to break adhesions and improve liquor circulation;

antiepileptic therapy is used for epileptic seizures;

in the treatment of arachnoiditis, the use of vasodilators that improve cerebral blood flow is effective: Cavinton, Vinpocetine, Cerebrolysin, Pentoxifylline, Trental, Curantyl;

recommended in the treatment of arachnoiditis to improve metabolism, regenerative processes and stimulate compensatory-adaptive mechanisms: intravenous administration of glucose with ascorbic acid, B vitamins, Cocarboxylase, aloe extract, FiBS, Cerebrolysin, Encephabol, Aminalon;

in fibrosing forms of arachnoiditis, Lidaza, Fibs, Pyrogenal, Encephabol, Cerebrolysin are used to resolve scar changes in the membranes of the brain;

Additional treatment for arachnoiditis

Additionally in the treatment of the disease:

lumbar puncture is used to alleviate well-being and condition;

surgery arachnoiditis involves the separation of membrane adhesions, removal of scars and cysts, which increase pressure on the substance and can cause disruption in the circulation of cerebrospinal fluid.

Causes of arachnoiditis

Arachnoiditis can manifest itself in following cases:

Chronic viral infection. These are herpes viruses types 1, 2 and 6, Epstein-Barr virus, cytomegalovirus and the common chickenpox virus. Due to the fact that viruses are now active, immunity is greatly reduced and full treatment arachnoiditis is possible only after full recovery immunity. Therefore, first of all, it is worth paying attention to increasing immunity in the body.

Inflammatory processes of the throat, nose and ear, inflammation of the tonsils.

Head injury. If you apply in time, the use of absorbable drugs will be sufficient. Good drugs Longidaza and Karipazim are considered in the treatment of arachnoiditis.

How does arachnoiditis develop?

The arachnoid membrane is located above the convolutions. It separates the subdural and subarachnoid spaces. Absent in the arachnoid membrane blood vessels. It consists of endothelial cells, collagen structures, arachnoid villi, and pachyonic granulations. These structures provide fixation in the cranial cavity and the outflow of cerebrospinal fluid from the subarachnoid space. The arachnoid membrane is characterized by significant permeability.

The subarachnoid space is the space between the arachnoid and choroid. It contains cerebrospinal fluid channels and cells that circulate cerebrospinal fluid. The production of cerebrospinal fluid occurs in the choroid plexuses of the ventricles, and the circulation of cerebrospinal fluid occurs in the ventricles, cisterns, cerebrospinal fluid channels and subarachnoid cells. The outflow of cerebrospinal fluid occurs through the arachnoid membrane, Pachionian granulations in circulatory system dura mater and brain.

The cerebrospinal fluid and circulatory systems are interconnected, which is important in the spread of arachnoiditis infection. The arachnoid membrane never suffers in isolation, since it does not have its own vascular apparatus. The development of arachnoiditis passes to the arachnoid membrane with inner surface hard shell. Soft tissue may be involved in the process meninges. Infection with arachnoiditis penetrates into the arachnoid space in the same way as with a brain abscess.

Aseptic inflammation is also possible, which may not be caused by microbial damage (with closed brain injury). The brain is normally surrounded by cerebrospinal fluid. When an inflammatory process develops, the circulation of cerebrospinal fluid is disrupted, resulting in difficulty in its outflow from the head to the spinal cord, and the cranial nerves are involved in the inflammatory process.

Prevention of the disease arachnoiditis is to be treated in time and not to develop diseases that provoke arachnoiditis, for example, such as otitis media, sinusitis, etc.