Disease arachnoiditis of the brain: symptoms and treatment. Brain arachnoiditis, which is not dangerous if treated promptly: how not to miss alarming symptoms

Arachnoiditis is an inflammatory lesion of the arachnoid membrane of the spinal cord and brain with the involvement of the pia mater in the pathological process.

Etiology of arachnoiditis

The disease can occur after general infections (pneumonia, influenza, measles), or develop against the background of focal infections (chronic, sinusitis, frontal sinusitis, rhinosinusitis), as well as traumatic brain injuries. In some cases, the disease may occur in patients with encephalitis and myelitis.

Pathogenesis of arachnoiditis

In the arachnoid membrane of the brain, reactive inflammation occurs as a result of exposure to a pathogen or its toxins, as a result of which there is a violation of lymph and blood circulation. There are several types of disease depending on the location and nature of the changes - these are cerebral, cystic, adhesive, adhesive-cystic and spinal arachnoiditis. The disease may be acute, subacute or chronic course.

As a result of impaired circulation of the cerebrospinal fluid, in some cases the development of hydrocephalus may occur:

— occlusive hydrocephalus occurs as a result of a violation of the outflow of fluid from the ventricular system of the brain;

— aresorptive hydrocephalus can develop as a result of impaired absorption of fluid through the dura mater due to the occurrence of an adhesive process.

Symptoms and treatment of arachnoiditis

Most often, the development of a subacute inflammatory process with its transition to chronic form. Clinical symptoms of the disease combine manifestations of cerebral disorders associated with intracranial hypertension or, which is much less common, with liquor hypertension and symptoms that reflect the predominant localization of the meningeal process.

Depending on the location of the inflammatory process, the following types of arachnoiditis are distinguished:

Cerebral arachnoiditis

This is an inflammatory lesion of the arachnoid membrane of the brain. The disease is most often localized on the convex surface of the brain, in the area of ​​its base, or in the area of ​​the postcranial fossa. For this species, is characteristic presence headaches that are hypertensive or meningeal in nature. As a rule, headaches are constant, with periodic intensification after hypothermia, overheating, or physical or mental stress. Focal neurological symptoms diseases depend on the location of the inflammatory process. Arachnoiditis of the convexital surface of the brain may be accompanied by the appearance of focal convulsive seizures. In especially severe cases, the occurrence of generalized convulsive seizures with loss of consciousness by the patient may occur, up to the occurrence of status epilepticus. As a result of pressure on the motor and sensory centers of the brain, movement disorders such as mono- and hemiparesis, as well as sensitivity disorders, may occur.

With basal arachnoiditis, inflammation is observed in the base of the brain, accompanied by general cerebral symptoms and dysfunction of the nerves that are located at the base of the skull.

Optico-chiasmatic arachnoiditis

Localized in the chiasmal region of the brain and can occur against the background infectious lesion paranasal sinuses, malaria, tonsillitis, syphilis, and also sometimes develops as a result of previous (concussion or bruise of the brain). With optico-chiasmatic arachnoiditis, multiple adhesions and cysts can form in the area of ​​the chiasm and the inner part of the optic nerves, while neuritis or stagnation are detected in the fundus area. Also, in some cases, hypothalamic metabolic disorders may be observed, such as obesity or. Arachnoiditis of the posterior cranial fossa is one of the most common forms of cerebral arachnoiditis. With this pathology, the localization of the inflammatory process occurs in the area of ​​the cerebellopontine angle and is most often accompanied by damage to the cranial nerves. Patients experience sharp, intense headaches in the back of the head due to increased intracranial pressure which may be accompanied by nausea, vomiting and dizziness. When examining the patient's fundus, stagnation phenomena are observed. Quite often, the symptoms of arachnoiditis of the posterior cranial fossa have a similar clinical picture to the development of a brain tumor. Arachnoiditis of the cerebellopontine angle - this disease has pronounced focal symptoms along with mild cerebral symptoms. The disease may cause hearing loss, impairment vestibular apparatus, as well as damage to the facial, abducens and trigeminal nerves. If the course of the disease is unfavorable, various cerebellar disorders may occur. Perhaps the development of spastic paresis of the limbs.

Spinal arachnoiditis

Inflammatory lesion of the arachnoid membrane of the spinal cord, which develops as a result of furunculosis, purulent abscesses of various locations or trauma. The inflammatory process is predominantly localized in back surface spinal cord. The first symptoms of the disease may appear several months or even years after the injury. The disease is characterized by pain and weakness in the limbs.

Adhesive arachnoiditis

Purulent inflammation of the arachnoid membrane of the brain, as a result of which adhesions may form between the membranes, which become the main cause of intense headaches.

Cystic arachnoiditis

An inflammatory disease of the arachnoid membrane of the brain, which is accompanied by the formation of cysts and is characterized by constantly occurring severe headaches.

Cystic adhesive arachnoiditis

Develops as a result of inflammatory damage to the meninges and their adhesion. It is characterized by the formation of separate areas in which adhesion of the membranes to the brain is observed. Such areas, under physical or mental stress, contribute to constant irritation of the cerebral cortex, which can lead to the development of seizures;

Arachnoiditis is also characterized by the development of some general symptoms:

— It occurs 10-12 days after the transfer infectious disease;

— Accompanied by intense;

— Accompanied by sleep disturbances;

- It is characterized by a decrease in performance;

- Always provokes decreased vision;

Treatment of arachnoiditis

When prescribing treatment, it is first necessary to establish the real source of infection in the patient’s body. After this, antibiotic therapy is recommended, and antihistamine medications are also indicated. Pathogenetic therapy consists of prescribing long-term courses of absorbable drugs, drugs that help normalize intracranial pressure and drugs that improve cerebral circulation and metabolism in brain tissue.

Arachnoiditis occurs as a result of acute and chronic infections, inflammatory diseases paranasal sinuses, chronic intoxication (alcohol, lead, arsenic), injuries (usually in the residual period). Arachnoiditis can also occur as a result of reactive inflammation with slowly growing tumors, encephalitis. In many cases, the cause of arachnoiditis remains unclear.

Morphologically, arachnoiditis is characterized by clouding and thickening of the arachnoid membrane, accompanied in more severe cases by fibrinoid deposits. In the further course of arachnoiditis, adhesions occur between the arachnoid and choroid, leading to disruption of the circulation of cerebrospinal fluid and the formation of arachnoid cysts.

Arachnoiditis can occur due to acute or more often chronic purulent otitis media (as a result of low-virulent microbes or toxins), as well as complications of purulent otitis media - labyrinthitis, petrositis, sinus thrombosis, as a consequence of cured purulent meningitis or brain abscesses and, finally, can be combined with non-purulent otogenic encephalitis. Otogenic arachnoiditis in most cases is localized in the posterior cranial fossa and much less often in the middle. The course of arachnoiditis can be acute, subacute and chronic.

Arachnoiditis is divided into diffuse and limited. The latter are extremely rare. Essentially we're talking about about more severe local changes against the background of a diffuse process in arachnoiditis.

A common manifestation of cerebral arachnoiditis is headaches of a hypertensive or meningeal nature.

Arachnoiditis of the convexital surface of the brain

Arachnoiditis of the convexital surface of the brain is more common in the anterior parts of the cerebral hemispheres, in the area of ​​the central gyri. Due to pressure on the motor and sensory centers, movement disorders (mono- or hemiparesis) and sensitivity may occur. Irritation, and in cases of cyst formation, compression of the cortex and underlying parts of the brain during arachnoiditis cause focal epileptic seizures.

In severe cases, generalized seizures up to the development of status epilepticus. Important To identify the localization of the focus of arachnoiditis, electroencephalography and MRI of the brain are used.

Optico-chiasmatic arachnoiditis

Opticochiasmatic arachnoiditis usually develops slowly. First, arachnoiditis affects one eye, then gradually (over several weeks or months) the other is also involved. The slow and often unilateral development of opticochiasmatic arachnoiditis helps differentiate the process from retrobulbar neuritis. The degree of vision loss in opticochiasmatic arachnoiditis can be different - from decreased vision to complete blindness. Often at the onset of the disease with opticochiasmatic arachnoiditis there is pain posterior to the eyeballs.

The most important aid in the diagnosis of opticochiasmatic arachnoiditis is the study of the visual fields (perimetry) and fundus (ophthalmoscopy). Fields of vision vary depending on the predominant localization of the process. The most typical are temporal hemianopsia (unilateral or bilateral), the presence of a central scotoma (often bilateral), and concentric narrowing of the visual field.

The symptoms of arachnoiditis in the posterior cranial fossa depend on the nature of the process (adhesions, cyst), localization, and also on the combination of arachnoiditis with hydrocephalus. An increase in intracranial pressure in arachnoiditis can be caused by the closure of the openings of the cerebral ventricles (Lushka, Magendie) due to adhesions, cysts or as a consequence of irritation of the soft meninges with hypersecretion of cerebrospinal fluid (primarily as a result of increased activity of the plexus chorioideus) and difficulty in its absorption. In the absence of a sharp increase in intracranial pressure, arachnoiditis can last for years, with long-term remissions. Arachnoiditis often occurs in the form of arachnoencephalitis due to concomitant inflammatory changes in brain tissue and pressure of adhesions and cysts on the brain.

Acute form arachnoiditis is characterized mainly by symptoms of increased intracranial pressure (severe headache, mainly in the back of the head, nausea, vomiting, dizziness, often congestive optic discs, sometimes bradycardia), pyramidal and focal symptoms are often absent or mild and inconsistent.

At subacute course in the neurological status, symptoms of damage to the posterior cranial fossa (most often the pontocerebellar space - the lateral cistern of the bridge) come to the fore. Symptoms of increased intracranial pressure, although they do occur, are less pronounced, and sometimes almost undetectable. Paresis of cranial nerves (V, VI, VII, VIII, less often IX and X and even less often III and IV), most often VIII pairs, is observed, and disturbances of vestibular function in combination with cerebellar symptoms predominate.

Along with instability in the Romberg position - deviation or fall towards the affected ear, unsteady gait, disturbances in index and finger-nose tests, adiadochokinesis, unstable spontaneous nystagmus (directed towards the affected ear or bilateral) - frequent disharmony of vestibular tests is noted (for example, loss of caloric reaction with preserved rotational reaction). Sometimes there is a change in the direction of nystagmus, positional nystagmus. Not all components of this vestibulo-cerebral syndrome are constant and clearly expressed. Homolateral pyramidal signs are rare and hemiparesis of the limbs is even more rare. In the cerebrospinal fluid, changes usually result in increased pressure, sometimes mild. Mild pleocytosis or increased protein content is rarely observed.

Arachnoiditis with other localizations in the posterior cranial fossa is very rare. This is an isolated lesion of the vestibulocochlear nerve in the internal ear canal, without symptoms of hypertension, prepontine arachnoiditis and arachnoiditis of the cerebellar hemispheres with static disturbances and scanty cerebellar symptoms, with damage to the trigeminal nerve (prepontine form), precerebellar arachnoiditis (anterior surface of one of the cerebellar lobes) with partial cerebellar symptoms, labyrinthine phenomena, inexcitability during caloric and decreased excitability during a rotation test, laterobulbar arachnoiditis with hypertension, cerebellar syndrome and damage to the IX, X, XI cranial nerves (homolateral), arachnoiditis of the posterior lacerated foramen with damage to the IX, X and XI cranial nerves.

Arachnoiditis of the spinal cord membranes (spinal)

Spinal arachnoiditis, in addition to the above reasons, can occur with furunculosis, purulent abscesses various localizations. The clinical picture of cystic limited spinal arachnoiditis is very similar to the symptoms of an extramedullary tumor. Available radicular syndrome at the level pathological process and conduction disorders (motor and sensory). Arachnoiditis is most often localized along the posterior surface of the spinal cord, at the level of the thoracic and lumbar segments, as well as in the cauda equina region. The process usually extends to several roots and is characterized by the variability of the lower limit of sensitivity disorders.

Pneumoencephalography has in some cases not only diagnostic, but also therapeutic significance. The injected air can break adhesions and thereby eliminate a number of symptoms (headaches, epileptic focal seizures, myoclonus).

• antibiotics (penicillin, streptomycin)
• methenamine
• iodine preparations and other absorbable agents
• anticonvulsants

X-ray therapy is prescribed for diffuse arachnoiditis of the meninges, for spinal arachnoiditis - physiotherapy, radon and hydrogen sulfide baths, mud applications.

The prognosis is favorable for life. With timely surgical treatment, disorders caused by limited arachnoiditis of the meninges are restored satisfactorily. Diffuse arachnoiditis of the meninges is less treatable. Dangerous are arachnoiditis of the brain membranes of the postcranial fossa, which can cause an acute attack of occlusion.

Medical and social examination and disability in cerebral arachnoiditis

Definition
Arachnoiditis (leptomeningitis) is a chronic diffuse autoimmune proliferative adhesive process predominantly of the arachnoid and pia mater of the brain.

From a clinical and expert point of view, it is important to distinguish between two pathogenetic variant cerebral arachnoiditis (Akimov G. A., Komandenko N., I., 1978; Lobzin V. S., 1983):

1. True (actual) arachnoiditis: an active adhesive process of an autoimmune nature, occurring with the formation of antibodies to the membranes of the brain, productive changes in the form of arachnoid endothelial hyperplasia, leading to the death of cells and obliteration of the cerebrospinal fluid channels in the subarachnoid space. Characteristic is the diffuse nature of the damage to the membranes, involving the molecular layer of the cortex, sometimes the ventricular ependyma, and the choroid plexus. The course is chronically progressive and intermittent.

2. Residual condition after neuroinfection or traumatic brain injury resulting in obliteration, fibrosis of the membranes (usually of limited extent), with the formation of adhesions and cysts at the site of necrosis. There is complete or partial regression of symptoms of the acute period (with the exception of epileptic seizures). Progression, as a rule, is absent.
This chapter discusses clinical and medical issues related only to patients with true (actual) arachnoiditis.

Epidemiology
The evolution of the clinical concept of the disease (identification of true clinically relevant arachnoiditis) forced us to reconsider previous ideas about its prevalence. Apparently, arachnoiditis accounts for about 3-5% of organic diseases of the nervous system (Lobzin V.S., 1983). It is twice as common in men. Young people (under 40 years old) clearly predominate. Overdiagnosis is the main reason for unjustified large quantity patients with cerebral arachnoiditis examined at the BMSE. For the same reason, true data on disability due to arachnoiditis are not available.

Etiology and pathogenesis
The disease is polyetiological. Main causes: influenza and other viral infections, chronic tonsillitis, rhinosinusitis, otitis media, traumatic brain injury. In general, infection is the cause of the disease in 55-60% of patients, closed craniocerebral injury - in 30%, in 10-15% it is difficult to definitely judge the etiological factor (Pil B.N., 1977; Lobzin V.S., 1983).
The most common cause of infectious arachnoiditis is influenza. Arachnoiditis develops within a period of 3-5 months to a year or more after influenza, which is explained by the time required for the autoimmune process to occur.
Rhinosinusogenic etiology is reliably established in 13% of all cerebral arachnoiditis (Gushchin A.N., 1995). The disease develops slowly, usually against the background of exacerbation of rhinosinusitis. After closed traumatic brain injury lucid interval also long-term (usually from 6 months to 1.5-2 years). The severity of the injury does not play a decisive role, although more often the adhesive membrane process is formed after a brain contusion or traumatic subarachnoid hemorrhage. The main pathogenetic factor is the formation of antibodies to antigens of damaged membranes and brain tissue.

Classification
Depending on the predominant localization, arachnoiditis is distinguished: 1) convexital; 2) basilar (in particular, opto-chiasmal, interpeduncular); 3) posterior cranial fossa (in particular, the cerebellopontine angle, the cistern magna). However, such rubrication is not always possible due to the diffuse nature of the adhesive process.
Taking into account the pathomorphological features, it is advisable to distinguish between adhesive and adhesive-cystic arachnoiditis.

Risk factors for occurrence, progression
1. Past acute infections (usually viral meningitis, meningoencephalitis).
2. Chronic focal purulent infections cranial localization (tonsillitis, sinusitis, otitis, mastoiditis, periodontitis and
etc.).
3. Closed craniocerebral injury, especially repeated.
4. Predisposing and exacerbating factors: severe physical labor in conditions of an unfavorable microclimate, overwork, alcohol and other intoxications, injuries of various locations, repeated influenza, acute respiratory viral infections.

Clinic and diagnostic criteria
1. Anamnestic information: 1) etiological risk factors; 2) development gradually, gradually. At first, often astheno-neurotic symptoms, irritative (epileptic seizures), then hypertensive (headache, etc.). Gradual deterioration of the condition, sometimes temporary improvement.
2. Neurological examination: general cerebral and local symptoms in varying proportions depending on the predominant localization of the process.

1) General cerebral symptoms. It is based on a violation of liquorodynamics (cerebrospinal fluid circulation), most pronounced during obliteration of the foramina of Magendie and Luschka, much less often due to chorioependimitis. Clinical symptoms are caused by intracranial hypertension (96%) or CSF hypotension (4%). Hypertensive syndrome is more common and most pronounced in arachnoiditis of the posterior cranial fossa, when in 50% of patients, against the background of focal symptoms, stagnant discs optic nerves. Headache (in 80% of cases), often morning, bursting, pain when moving eyeballs, physical stress, straining, coughing, nausea, vomiting. Also include: dizziness of a non-systemic nature, tinnitus, hearing loss, autonomic dysfunction, increased sensory excitability (intolerance to bright light, loud sounds, etc.), weather dependence. Neurasthenic manifestations (general weakness, fatigue, irritability, sleep disturbance) are common.

Liquorodynamic crises(acutely occurring dyscirculatory disorders), manifested by increased cerebral symptoms. It is customary to isolate the lungs (short-term increase in headache, moderate dizziness, nausea); moderate severity (more severe headache, poor general health, vomiting) and severe crises. The latter last from several hours to 1-2 days and are manifested by severe headache, vomiting, general weakness, impaired adaptation to external influences. Autonomic-visceral disorders are also common. Depending on the frequency, there are rare (1-2 times a month or less), medium frequency (3-4 times a month) and frequent (more than 4 times a month) crises.

2) Local or focal symptoms. They are determined by the predominant localization of organic changes in the membranes of the brain and adjacent structures. Overall for focal symptoms characterized by a predominance of irritation rather than loss. An exception is opticochiasmatic arachnoiditis.
- convexital arachnoiditis (in 25% of patients, more often of traumatic etiology). The predominance of local symptoms is characteristic (depending on the damage to the area of ​​the central gyri, parietal, temporal). In the cystic form of arachnoiditis, there are usually mild or moderate motor and sensory disturbances ( pyramidal insufficiency, mild hemi- or monoparesis, hemihypesthesia). Epileptic seizures are typical (in 35% of patients), often the first manifestation of the disease. Secondary generalized partial seizures (Jacksonian) are common, sometimes with transient postparoxysmal neurological deficit (Todd's palsy). Polymorphism of seizures is characteristic due to the frequent temporal localization of the process: simple and complex (psychomotor), partial with secondary generalization, primary generalized, their combination. EEG reveals epileptic activity in 40-80% of patients (according to various sources), including peak-slow wave complexes. General cerebral symptoms are moderate, severe headaches, crisis states more often during exacerbation;
- basilar arachnoiditis (in 27% of patients) can be widespread or localized mainly in the anterior, middle cranial fossa, in the interpeduncular or optic-chiasmatic cistern. With significant spread, many cranial nerves at the base of the brain (I, III-VI pairs) are involved in the adhesive process, which determines the clinical picture of the disease. Pyramidal insufficiency is also possible. General cerebral symptoms are mild and moderate. Mental disorders (fatigue, decreased memory, attention, mental performance) are more often observed with arachnoiditis of the anterior cranial fossa.
The most distinct symptoms are in the case of optico-chiasmatic arachnoiditis. Currently, it is rarely diagnosed, since in the vast majority of cases, chiasmatic syndrome is caused by other causes (see “Differential diagnosis”). More often it develops after a viral infection (flu), trauma, or against the background of sinusitis. General cerebral symptoms are mild or absent. Initial symptoms are the appearance of a grid before the eyes, a progressive decrease in visual acuity, often immediately bilateral, over 3-6 months. In the fundus - first neuritis, then atrophy of the optic discs. The field of view is concentric, less often bitemporal narrowing, unilateral or bilateral central scotomas. Endocrine metabolic disorders are possible due to the involvement of the hypothalamus in the process;
- arachnoiditis of the posterior cranial fossa (in 23% of patients), usually post-infectious, otogenic. A severe, pseudotumorous course is often encountered due to severe disturbances in cerebrospinal fluid dynamics, damage to the caudal cranial nerves, and cerebellar symptoms. With predominant localization in the region of the cerebellopontine angle, damage to the VIII pair of cranial nerves (tinnitus, hearing loss, dizziness) appears earlier. Subsequently, the facial nerve suffers, cerebellar insufficiency and pyramidal symptoms are detected. The first symptom of the disease may be facial pain as a consequence of trigeminal neuropathy. Arachnoiditis of the cistern magna and adjacent formations is characterized by the greatest severity of hypertensive syndrome due to obliteration of the cerebrospinal fluid ducts and impaired outflow of cerebrospinal fluid. Severe crises are frequent, pronounced cerebellar symptoms. A complication is the development of a syringomyelitic cyst. In view of serious condition patients sometimes have to resort to surgical intervention.

3. Data additional research . The need for adequate assessment due to the difficulties and frequent errors in diagnosing arachnoiditis. It is incorrect to judge true (actual) arachnoiditis only on the basis of morphological changes detected on PEG, CT, MRI studies without taking into account the characteristics of the clinical picture, the course of the disease (progression of the first symptoms, the appearance of new symptoms). Therefore, it is necessary to objectify complaints indicating hypertensive syndrome, visual impairment, frequency and severity of crises, and epileptic seizures.
Only a comparison of clinical data and the results of additional studies provides grounds for diagnosing true current arachnoiditis and distinguishing it from residual stable conditions:
- craniogram. Symptoms that are sometimes detected (digital indentations, porosity of the dorsum sella usually indicate a past increase in intracranial pressure (long-standing traumatic brain injury, infection) and cannot in themselves indicate current arachnoiditis;
- echo-EG allows you to obtain information about the presence and severity of hydrocephalus, but does not allow you to judge its nature (normotensive, hypertensive) and cause;
- lumbar puncture. CSF pressure is increased to varying degrees in half of the patients. With exacerbation of arachnoiditis of the posterior cranial fossa, basal water levels can reach 250-400 mm of water. Art. lying down. A decrease in pressure occurs with chorioependimitis. Number of cells (up to several tens
in 1 µl) and protein (up to 0.6 g/l) increases in case of process activity, in other patients it is normal, and the protein content is even below 0.2 g/l;
- PEG is important diagnostic value. Signs of adhesive arachnoiditis, scar changes, internal or external hydrocephalus, atrophic process. At the same time, PEG data can be the basis for the diagnosis of true arachnoiditis only if the clinical features and course of the disease are taken into account. They are often evidence of residual changes in the subarachnoid space and brain substance after injury, neuroinfection, and occur in patients with epilepsy without clinical signs of arachnoiditis;
- CT, MRI make it possible to objectify the adhesive and atrophic process, the presence of hydrocephalus and its nature (aresorptive, occlusive), cystic cavities, and exclude space-occupying formations. CT cisternography allows us to identify direct signs of changes in the configuration of the subarachnoid spaces and cisterns. However, the information obtained has diagnostic value only with an adequate assessment of the lumbar puncture data (especially the state of liquor pressure) and the clinical picture of the disease as a whole;
- EEG reveals foci of irritation in convexital arachnoiditis, epileptic activity (in 78% of patients with epileptic seizures). These data only indirectly indicate the possibility of an adhesive process and do not in themselves constitute a basis for diagnosis;
- immunological studies, determination of the content of serotonin and other neurotransmitters in the blood and cerebrospinal fluid are important for judging the activity of the inflammatory meningeal process, the degree of involvement of the brain substance in it;
- ophthalmological examination is used for diagnostic purposes not only for opto-chiasmal, but also diffuse arachnoiditis due to the frequent involvement of the visual pathways in the pathological process;
- otolaryngological diagnosis is important primarily for determining the etiology of arachnoiditis;
- experimental psychological research allows you to objectively assess the condition mental functions, degree of asthenia of the patient.

Differential diagnosis
1. With a volumetric process (especially important and most responsible). Based on the features of the clinical picture and its dynamics. Difficulties are more common when benign tumors posterior cranial fossa, pituitary gland and sellar region.
2. Optico-chiasmatic arachnoiditis: a) with retrobulbar neuritis, mainly with multiple sclerosis, especially if observed at the onset of the disease. Some clinical features retrobulbar neuritis: remitting course; usually unilateral lesion; clinical dissociation between visual acuity and the severity of changes in the fundus; rapid (within 1-2 days) decrease in visual acuity, its fluctuations during the day and spontaneous (over several hours, days, weeks) recovery to tenths or 1.0; instability of central scotomas;
b) with Leber's hereditary optic atrophy: gender-related inheritance, progressive decline in visual acuity in both eyes without remissions. Despite the available information about the presence of adhesions in the chiasmatic region, it cannot be considered chiasmatic arachnoiditis;
c) with a tumor of the chiasmal-sellar region.
3. With neurosarcoidosis. Damage to the meninges is a frequent and clinically most striking manifestation of the sarcoidosis granulomatous process (Makarov A. Yu. et al., 1995). Develops in 22% of patients with sarcoidosis organic damage to the nervous system against the background of pulmonary or peripheral granulomatosis lymph nodes. Sarcoid granulomas are localized in the pia and arachnoid membranes, mainly at the base of the brain. The process can be diffuse and limited, most often in the opto-chiasmal localization, much less often in the posterior cranial fossa. Granulomas also occupy the hypothalamic-pituitary region, which sometimes manifests itself as severe diabetes insipidus, other endocrine disorders. At the base of the brain, multiple granulomas are easily detected by MRI. The clinical picture corresponds to the predominant location of granulomas. Liquorodynamic disturbances and hydrocephalus are most pronounced with widespread arachnoiditis. During an exacerbation, there may be a slight lymphocytic pleocytosis in the cerebrospinal fluid. Sarcoidosis is actually one of the etiological factors of arachnoiditis. However, the peculiarities of pathogenesis (a productive process against the background of specific granulomas), good curability (corticosteroids, presocial, plaquenil, antioxidants), damage to the membranes, along with sarcoidosis of the lungs and other internal organs, force us to consider it an independent disease.
4. With the consequences of a closed or open craniocerebral injury (usually severe), neuroinfection (meningitis, meningoencephalitis) with residual adhesive, fibrous, cystic changes in the membranes, usually limited, without a progressive course of the disease. Epileptic seizures in this situation are not a basis for diagnosing true current arachnoiditis. The same should be kept in mind in the case of idiopathic epilepsy, when local membrane changes are detected by PEG or imaging methods.
5. With neurosis (usually neurasthenia) or neurosis asthenic syndrome for organic diseases and injuries of the nervous system (due to frequent mental disorders in the clinical picture of actual arachnoiditis).

Course and prognosis
They are largely determined by the etiology, the predominant localization of the adhesive process. The basis for diagnosing true arachnoiditis is a chronic course with exacerbations. A certain regression is possible, a state of relative (sometimes long-term) compensation, which more often occurs with age due to the atrophic process and, as a consequence, a decrease in the severity of liquor dynamics disorders. Clinically, the prognosis is usually favorable. It is worse in the opticochiasmal form, better in the convexital form. The danger is represented by arachnoiditis of the posterior cranial fossa with occlusive hydrocephalus. The course of the disease and sometimes the prognosis are aggravated by other consequences of trauma and neuroinfections, which act as an etiological factor for arachnoiditis. The labor prognosis is worse in patients with frequent relapses, crises, epileptic seizures, and progressive deterioration of vision.

Principles of treatment
1) Should be carried out in a hospital after diagnosis using additional methods and conclusions about true (actual) arachnoiditis.
2) Determined by etiology (presence of a focus of infection), predominant localization and activity of the adhesive process.
3) Repetition of courses and duration of drug therapy:
a) glucocorticoids (prednisolone) at a dose of 60 mg per day for 2 weeks;
b) absorbable (bioquinol, pyrogenal, rumalon, lidase and
etc.);
c) dehydration (with increased intracranial pressure);
d) antihistamine, antiallergic (fenkarol, tavegil, diphenhydramine, etc.);
e) stimulating metabolic processes in the brain (nootropics, cerebrolysin, etc.);
f) correcting concomitant mental disorders (tranquilizers, sedatives, antidepressants);
g) antiepileptic drugs (taking into account the nature of epileptic seizures).
4) Surgery. Indications taking into account the nature of the course and severity of clinical manifestations in opticochiasmatic arachnoiditis, posterior cranial fossa. Stimulation of the optic nerves through implanted electrodes with a significant decrease in visual acuity. In addition, sanitation of foci of infection (sinusitis, otitis media, etc.).

Medical and social examination Criteria of VUT

1. During primary diagnosis, treatment. Depending on the severity of the disease, VN from 1 to 3 months. Continuation of treatment on sick leave, taking into account the nature of the process, the degree of restoration (compensation) of impaired functions - on average for another 1-2 months (if possible, in the future, return to work in your specialty or lower qualifications with a decrease in earnings).
2. For exacerbations of VN for 3-4 weeks or more, depending on their severity and the effectiveness of therapy (for the period of inpatient or outpatient treatment). The profession and working conditions are taken into account: longer periods for work associated with physical stress, performed under the influence of others unfavorable factors in the process of labor (psycho-emotional, visual, vestibular, etc.).
3. After a severe crisis - sick leave for 3-4 days.
4. After surgery for arachnoiditis of the posterior cranial fossa, optochiasmatic (usually at least 3-4 months with subsequent referral to BMSE).

Main causes of disability
1. Violation visual functions: progressive decrease in acuity and narrowing of the visual field. Social insufficiency occurs when the ability to orientate and the ability to have detailed vision is limited or lost. In this regard, the ability to work in many professions is limited or lost, or patients need constant outside help.
2. Disturbances in cerebrospinal fluid dynamics, manifested, as a rule, by hypertensive syndrome with repeated crisis conditions. Confirmed during inpatient examination, in particular by the results of lumbar puncture, hypertensive crises limit the life activity of patients. During a crisis of moderate severity, and especially severe, there may be a disorder of orientation, the ability to make decisions is reduced, which leads to a temporary inability to continue working. Repeated crises, especially those accompanied by dizziness and autonomic disorders, can significantly limit the life activity and ability of patients to work.
3. Epileptic seizures lead to limited life activity and disability due to the patient’s periodic loss of control over his behavior, which makes it impossible to work in a number of professions.
4. Astheno-neurasthenic syndrome, accompanying autonomic dystonia lead to maladaptation (reduced endurance to climatic factors, noise, bright lighting, and work stress). This limits the life activity of patients depending on the nature and conditions labor activity.
5. The combination of these syndromes with cerebellar and vestibular disorders (mainly with arachnoiditis of the posterior cranial fossa) aggravates the degree of disability due to impaired locomotor ability and decreased manual activity. This can cause limitations and sometimes loss of ability to work.
- cerebral arachnoiditis of the posterior cranial fossa (otogenic) with severe hypertensive syndrome, frequent severe crises, moderate vestibular and cerebellar disorders in the acute stage;
- cerebral arachnoiditis (post-traumatic) of convexital localization with rare secondary generalized epileptic seizures, mild and rare hypertensive crises in remission;
- consequences of a closed craniocerebral injury in the form of mild stem organic symptoms, optico-chiasmatic arachnoiditis with partial atrophy of the optic nerves of both eyes, a moderate decrease in visual acuity and a concentric narrowing of the visual field, pronounced asthenic syndrome, with a slowly progressive course.

Contraindicated types and working conditions
1) General contraindications: significant physical and mental stress, exposure to adverse factors during the work process (meteorological, vibration, noise, contact with toxic substances, etc.).
2) Individual - depending on the main syndrome or a combination of several clinically significant disorders: visual, liquorodynamic, epileptic seizures, vestibular dysfunction, etc. For example, with significant visual impairments, patients are not able to work that requires constant visual strain or clear distinction of colors (corrector, engraver , computer operator, artist, colorimetrician, etc.).

able-bodied patients
1. With rare exacerbations (long-term remission) with mild disturbances in cerebrospinal fluid dynamics, rare epileptic seizures or their absence, moderation of other disorders that do not affect the ability to continue working in the specialty (sometimes with minor restrictions on the recommendation of the CEC), without social insufficiency.
2. In the compensation stage after successful therapy, rationally employed (often previously recognized as having limited ability to work).
1. Persistent severe dysfunction (despite treatment). Primarily hypertensive syndrome, epileptic seizures, visual defect.
2. Progressive course with repeated exacerbations, an increase in neurological symptoms, which necessitates a transition to work with a decrease in qualifications or a significant decrease in volume production activities.

Minimum required examination when referring to BMSE
1. Results of cerebrospinal fluid examination (pressure, composition of cerebrospinal fluid), preferably in dynamics.
2. PEG, CT, MRI data.
3. Craniogram.
4. Echo-EG.
5. EEG.
6. Results of ophthalmological (required fundus, visual acuity and field of vision over time) and otorhinolaryngological examination.
7. Data from experimental psychological research.
8. Clinical tests blood, urine.

Disability criteria

Group III: social insufficiency caused by the need to change working conditions depending on the nature of the dysfunction (epileptic seizures, hypertensive syndrome, visual impairment, etc.). Patients need a significant reduction in the amount of work or retraining due to loss of profession (according to the criteria of limited ability to navigate, work activity of the first degree). During the next re-examination, it is necessary to take into account that successful rehabilitation (favorable course of the disease, rational employment) is the basis for recognizing the patient as able to work.

Group II: severe limitation of life activity due to the progressive course of the disease, frequent exacerbations, persistent severe visual impairment (decrease in visual acuity from 0.04 to 0.08 in the better seeing eye, narrowing of the visual field to 15-20°), liquorodynamic disorders with frequent severe crises, frequent epileptic seizures, vestibular, cerebellar dysfunction or a combination of these disorders (according to the criteria of limited ability to work of the second or third degree, to orientation, control of one’s behavior of the second degree). Favorable treatment results and relative stabilization in the course of the disease determine the possibility of positive dynamics of disability.

Group I: rarely determined, as a rule, with opticochiasmatic arachnoiditis (complete blindness, decreased visual acuity to 0.03 in both or better seeing eyes, as well as a sharp narrowing of the visual field to 10° or less in all meridians) - according to the criteria restrictions on the ability to navigate and self-care of the third degree.

In the case of persistent and irreversible visual impairment, after observation for 5 years, the disability group is established without specifying the period for re-examination.

After surgical treatment for arachnoiditis of the posterior cranial fossa or opto-chiasmatic arachnoiditis, the first examination usually determines disability group II; in the future, the expert decision depends on the results of the operation.

Causes of disability: 1) general illness; 2) work injury (with post-traumatic arachnoiditis); 3) disability due to a disease acquired during military service and other military reasons.

Prevention of disability

Primary prevention: 1) warning viral diseases(flu, etc.), which are the cause of arachnoiditis;
2) timely treatment of inflammatory processes of cranial localization (rhinosinusitis, otitis, tonsillitis, etc.); 3) adequate treatment of victims with traumatic brain injury (including mild).

Secondary prevention: 1) timely diagnosis and optimal therapy for a patient diagnosed with arachnoiditis; 2) compliance with the terms of the VT, taking into account the severity of the exacerbation, the nature and working conditions; 3) dispensary observation(2 times per year), repeat courses anti-relapse therapy, including in dispensaries and sanatoriums.

Tertiary prevention: 1) prevention of relapses by eliminating risk factors for disease progression, including during work (taking into account contraindications depending on the main clinical syndrome);
2) if necessary, timely surgical treatment;
3) reasonable determination of disability, retraining and training of disabled people of group III with subsequent employment.

Rehabilitation
An individual rehabilitation program should be drawn up taking into account the severity of clinical manifestations, the predominant localization of the adhesive process and the characteristics of the course of the disease. The rehabilitation potential in patients with actual arachnoiditis is usually quite high (the exception is the severe form of opticochiasmatic arachnoiditis). It is possible to achieve the level of complete or partial rehabilitation.
To the program complete rehabilitation(for patients with mild or moderate disability, a relatively favorable course of the disease) includes clinical observation, anti-relapse treatment, in particular, psychotherapy, in a hospital, clinic, dispensary; measures for rational employment by creating easier working conditions based on the conclusion of the VC.

The partial rehabilitation program (for patients with moderate or significant disabilities) should include more active therapeutic measures, and, if necessary, surgical treatment; rational employment by ensuring a reduced volume of production activity or transfer to another job, which may be associated with loss of profession. In this regard, it is determined
III disability group and retraining is required. The latter is carried out taking into account the clinical characteristics of the disease, age^, general educational training through training at a technical school, vocational school of the system social protection, individual apprenticeship. Examples of available professions: repairman household appliances, television and radio equipment, process technician, livestock specialist, administrator, manager, etc.
Positive dynamics of disability and return to work without restrictions, subject to effective treatment, the use of adequate measures of professional and social rehabilitation is achieved in 70-80% of patients with cerebral arachnoiditis.

There are many diseases that can lead to disability or death. One of them is cerebral arachnoiditis. With this disease, sick people need immediate and effective treatment. With timely treatment, the prognosis for life is favorable. How can cerebral arachnoiditis be diagnosed? How is he treated? Before answering these questions, it is worth understanding what arachnoiditis is and how it is classified.

What is arachnoiditis?

The human brain and spinal cord are covered with three arachnoid (arachnoid) and soft tissue. Inflammation of the arachnoid membrane is a disease called arachnoiditis. In 60% of cases, the disease is provoked by infectious and infectious-allergic diseases. In 30% of cases, arachnoiditis occurs due to a previous traumatic brain injury. In the remaining people diagnosed with the disease, the etiology cannot be determined.

The term "arachnoiditis" has not found application in practice. Experts explain this by saying that there is no isolated lesion of the arachnoid mater, because it does not have its own vascular system. Signs of arachnoiditis in modern medicine referred to as serous meningitis.

Classification of the disease

Depending on the location of the pathological process, several types of disease are distinguished. One of them is spinal arachnoiditis. In this disease, inflammation occurs in the meninges that surround the spinal cord. Another type is cerebral arachnoiditis. It affects only the lining of the brain. Cerebrospinal arachnoiditis is characterized by a combination of the two above-mentioned types of disease.

There is another classification. According to it there are the following types ailment, this is arachnoiditis:

• posterior cranial fossa;
• bases of the brain (basal);
• convex surface of the cerebral hemispheres (convexital);
• in the area of ​​the optic chiasm (optic-chiasmal);

Depending on the morphological changes, the following are distinguished:

• sticky;
• adhesive-cystic;

Causes of cerebral arachnoiditis

This disease can occur as a complication of various infectious diseases, or develop due to inflammatory processes occurring in the middle ear and paranasal sinuses. Thus, to causal factors include rheumatism, influenza, chronic tonsillitis, otitis media, rhinosinusitis, measles, scarlet fever, etc.

The cause of the disease is sometimes traumatic brain injury. This is post-traumatic cerebral arachnoiditis. Some experts believe that the disease can occur after a birth injury and make itself felt in adulthood after injury or infection.

General cerebral symptoms

Cerebral arachnoiditis is characterized by certain clinical manifestations. First of all, the disease makes itself felt by general cerebral symptoms. Headache is common. It is strongest in the morning. In some people it is accompanied by nausea and vomiting.

Headache may worsen with tension, straining, or awkward movements. In addition to it, people with cerebral arachnoiditis report dizziness. In patients, memory deteriorates, irritability appears, fatigue quickly sets in, sleep is disturbed, and general weakness is observed.

Symptoms reflecting the localization of the pathological process

They are not the only ones associated with the disease “cerebral arachnoiditis”. Additional symptoms may also occur, which reflect the localization of the meningeal process:

1. With arachnoiditis of the posterior cranial fossa, ataxia is observed. This is a violation of the coordination of muscle movements in the absence of muscle weakness. Nystagmus also occurs. This term refers to spontaneous movements of the eyeballs.
2. The basal type of the disease is characterized by dysfunction of those nerves that are located at the base of the skull.
3. With convexital arachnoiditis, general and Jacksonian epileptic seizures can be observed.
4. The opticochiasmal type of disease is characterized by deterioration of vision. Sick people note a “mesh before the eyes.” In severe cases of the disease, blindness occurs. Sometimes hypothalamic disturbances occur (for example, increased urination, thirst).
5. With arachnoiditis of the cerebellopontine angle, people suffer from a headache localized in occipital region, noise in ears. Patients experience paroxysmal dizziness.

Diagnosis of cerebral arachnoiditis

The diagnosis is made by specialists taking into account the clinical manifestations of the disease and the results of a neurological examination. It includes studies of visual acuity, visual fields and fundus. Craniography is also performed. This is without contrast. In case of cerebral arachnoiditis, craniograms can reveal indirect signs intracranial hypertension.

An electroencephalogram of the brain is also performed. The main role in diagnosis is played by a pneumoencephalogram. The study allows us to detect uneven filling of the subarachnoid space with air, expansion of the ventricles of the brain, and focal accumulations of air. To obtain additional information and exclude other diseases, sick people are prescribed:

• CT scan;
• angiography;
• Magnetic resonance imaging;
• scintigraphy;
• other diagnostic methods.

Elimination of the disease

The disease cerebral arachnoiditis must be treated over a long period of time, in courses. To eliminate the source of infection, doctors prescribe antibiotics to their patients. The following tools are also used:

• anti-inflammatory;
• absorbable;
• hyposensitizing;
• dehydration, etc.

When intracranial pressure increases, diuretics (for example, Furosemide, Mannitol) and decongestants are needed. If patients experience seizures, doctors prescribe antiepileptic drugs. If necessary, symptomatic medications are used.

Surgery

The use of medications does not always help eliminate a disease such as cerebral arachnoiditis. Treatment in some cases is surgical. Indications for surgical intervention are:

• lack of improvement after drug therapy;
• increase in intracranial hypertension;
• increase in focal symptoms;
• the presence of opticochiasmatic arachnoiditis, which is characterized by a steady deterioration of vision.

For example, a neurosurgical operation can be performed when an adhesive process develops with the formation of adhesions or a cystic process in a disease such as cerebral arachnoiditis of the brain. Treatment of this kind will allow you to get rid of obstacles that violate normal circulation cerebrospinal fluid.

Prognosis and ability to work in cerebral arachnoiditis

Usually, the patient’s life is not in danger if treatment is started in a timely manner. A good prognosis is given for the convexital form of the disease. It is worse with opticochiasmal inflammation. Arachnoiditis of the posterior cranial fossa with occlusive hydrocephalus is especially dangerous. It is worth noting that the prognosis can significantly worsen existing diseases and injuries.

People due to an illness can be recognized as group III disabled if light work reduces the volume of their production activity. With severe deterioration of vision and frequent convulsive seizures, group II disability is established. People become disabled in group I due to vision loss caused by opticochiasmatic arachnoiditis.

Causes of disability

It was said above that cerebral arachnoiditis can lead to disability. Thus, the disease provokes a limitation of life activity, that is, patients completely or partially lose the opportunity or ability to carry out the main components of everyday life. This happens for the following reasons:

1. Convulsive seizures. Sick people periodically lose control over their behavior. In this regard, life activity is limited and ability to work is impaired.
2. Deterioration of visual functions. In people suffering from cerebral arachnoiditis, visual acuity decreases and the field of vision narrows. They cannot work with small details, perform their professional responsibilities, requiring visual strain. Some people constantly need help from people around them due to blindness.
3. with the disease cerebral arachnoiditis. Consequences - the manifestation of hypertensive syndrome with repeated occurrences is accompanied by dizziness and disorientation.
4. Neurasthenia and concomitant vegetative dystonia. People's endurance to climatic factors decreases, and the ability to endure prolonged physical and mental stress is lost. Patients react negatively to loud sounds and too bright light.

Disease prevention

Cerebral arachnoiditis can be avoided. So, in order not to encounter this disease, it is necessary to pay attention to its prevention. It consists of timely treatment of those ailments that can provoke arachnoiditis. For example, when the first signs of sinusitis or otitis appear, you should immediately consult a doctor. The specialist will prescribe effective therapy in a timely manner. Adequate treatment necessary for traumatic brain injury.

In conclusion, it is worth noting that cerebral arachnoiditis of the brain is a disease that is not so easy to diagnose. For suspicious symptoms, prescribed various studies. Differential diagnosis is also carried out, because many diseases have a similar clinical picture(eg, brain tumors, normal pressure hydrocephalus, neurosarcoidosis, multiple sclerosis, idiopathic epilepsy).

Arachnoiditis of the brain is a disease associated with the inflammatory process of the meninges. In this case, the spaces serving for the outflow of cerebrospinal fluid begin to narrow, and cerebrospinal fluid accumulates in the cavity of the cranium. The cause of arachnoiditis can be an allergy, autoimmune, viral or bacterial disease. Most often the disease is diagnosed in young people. If timely treatment is started, the disease has a favorable prognosis. How to determine the development of cerebral arachnoiditis? What is the treatment?

Pathogenesis of the disease

To understand what arachnoiditis is, it is necessary to understand the process of its development. Between the hard and soft membranes of the brain there is connective tissue that looks like a spider's web. It is separated from the soft shell by the subarachnoid space, in which cerebrospinal fluid circulates and blood vessels are located, the task of which is to nourish the brain.

The picture shows the membranes of the brain

As a result of infection, an inflammatory process occurs, which leads to clouding of the membrane and the appearance of compactions in it. Thus, adhesions appear between the arachnoid membrane and the blood vessels, interfering with fluid circulation. Gradually, cysts appear here.

Inflammation of the arachnoid membrane leads to the following:

1. Disorders of fluid outflow.
2. Impaired absorption of cerebrospinal fluid through outer shell brain.

With an autoimmune disease, it is possible to produce antibodies that have an inhibitory effect on the tissue of the arachnoid membrane. In this case, the inflammatory process can occur only in this one membrane. This condition It is commonly called true arachnoiditis.

Georgy Aleksandrovich Ermakov, an immunologist at the Moscow Doctor clinic, will tell you more about the pathology, its symptoms, risk groups and treatment methods:

If the disease occurs after an injury or infection, then this condition is called residual. Most patients are young people under 40 years of age. Children, people with weakened immune systems, metabolic disorders, and those suffering from alcohol or drug addiction are also at risk. Moreover, men are susceptible to the disease 2 times more often than women.

Causes

The main causes of cerebral arachnoiditis include:

• Past viral diseases (influenza, measles, cytomegalovirus, etc.).
• Diseases of the respiratory or hearing organs (sinusitis, tonsillitis, etc.).
• The patient has a history of meningitis or meningoencephalitis.

• Traumatic nature of arachnoiditis (after suffering traumatic brain injuries).
• Abscesses or growths that may appear inside the skull.

Most patients are people living in unfavorable climatic conditions with weakened immunity. The development of arachnoiditis can be provoked by poisoning with alcohol, lead and other heavy metals, vitamin deficiency or physical fatigue.

In half of all cases there is a close relationship with viral infection when the meninges are involved. Approximately a third of patients suffered a traumatic brain injury, after which they developed post-traumatic arachnoiditis. The most common cause is brain contusion or hemorrhage.

Quite often, arachnoiditis is preceded by diseases of the ENT organs. This is due to the fact that the throat tonsils, sinuses and parts of the ear are in close proximity to the brain, therefore, if inflammation occurs in them or an infection occurs, then there is a high probability of it penetrating into the skull.

In 10-15% of all cases of the disease, it is not possible to determine the cause of arachnoiditis. In this case, a diagnosis is made - idiopathic arachnoiditis.

Symptoms of pathology

Signs by which a doctor may suspect a disease are a set of symptoms of a cerebral disorder. However, there are also symptoms characteristic of arachnoiditis:

1. Headache in some cases accompanied by nausea and even vomiting. It mainly bothers the patient in the morning. The pain is local. After any effort (sudden movement, straining, etc.), its manifestations intensify.
2. Dizziness.

1. General weakness of the body.
2. Sleep disorders.
3. Memory impairment.
4. Increased irritability.

Dr. Myasnikov Alexander Leonidovich in the program “About the Most Important Thing” will talk about the most alarming clinical causes of sharp and severe headaches:

As a rule, during the disease the entire surface of the arachnoid membrane becomes inflamed. In the case of limited arachnoiditis, disturbances occur in a separate area. Depending on where the source of the disease is located, the following symptoms are possible:

• The convexital type of arachnoiditis is manifested by irritation of the brain. In this case, the patient may experience seizures similar to epileptic ones.
• If the swelling is more developed in the occipital region, hearing and vision impairment occurs. The patient notes loss of the visual field, and during a fundus examination, the doctor may note optic neuritis.

• The patient reacts sharply to changes in weather. At the same time, he experiences excessive sweating or chills. In some cases, a person complains about constant feeling thirst. Sometimes there is an increase in body weight.
• When the cerebellar angle is damaged, pain occurs in the occipital part of the head, dizziness and tinnitus. There is an imbalance.

The figure shows the largest cisterns of the subarachnoid space. Depending on the location of the inflammation, the patient experiences different clinical manifestations of the disease.

• Cystic arachnoiditis may have various manifestations, which are associated with the nature of adhesions. If it does not lead to an increase in ICP, the disease may not be detected for several years. During this time, balance gradually deteriorates and synchronization is lost.
• When the anterior lobes of the brain are damaged, memory decreases, the patient’s psychological state is disrupted, convulsions and various mental abnormalities appear.
• It is very difficult to identify adhesive cerebral arachnoiditis, since it is not characterized by localization of manifestations, and the symptoms are similar to those of many diseases.
• If arachnoiditis affects the occipital cisterns, then signs of damage appear facial nerve. The patient's body temperature rises.

It is worth noting that cerebral arachnoiditis does not develop spontaneously. From the moment of an infectious disease to the appearance of the first symptoms, at least several months or even 1 year can pass. In case of injury, the disease can make itself felt only 2 years after brain damage. Phases of exacerbation of the disease are always followed by periods of remission.

The onset of the pathology is subacute. The patient complains of irritability, headache or dizziness, constant weakness and fatigue. Over time, as the inflammatory process progresses, focal or cerebral signs of the disease appear.

Neurologist Mikhail Moiseevich Shperling talks about the symptoms of increased intracranial pressure:

This disease is characterized by the formation of adhesions and fusion of the membranes of the brain, as a result of which the outflow of cerebrospinal fluid is necessarily disrupted. When cerebrospinal fluid accumulates in the subarachnoid space or cysts, this leads to expansion of the brain cavities. Thus, intracranial pressure increases, which is considered one of the main symptoms of the disease.

Diagnosis of brain arachnoiditis

In most cases obvious signs arachnoiditis of the brain, which can be called dizziness, frequent headaches with regular nausea and vomiting do not cause suspicion in the patient. On initial stage they appear several times during the month and only when the disease becomes chronic do they occur often enough and last a long time, so they force the person to seek medical help.

The difficulty is that the symptoms developing arachnoiditis are characteristic of a large number of ailments, so treatment is often delayed. To make an accurate diagnosis, the doctor will need to conduct a number of examinations:

1. Ophthalmological examination. The most common type of disease is opticochiasmatic arachnoiditis. Approximately half of patients have signs of posterior fossa involvement.
2. Magnetic resonance imaging. This method The study makes it possible to establish the presence of inflammation in the brain in 99% of cases. The examination reveals the presence of cysts and inflammation in the arachnoid membrane of the brain. It also allows you to exclude other pathologies that have the same manifestations (abscess, tumor, etc.).

Accumulation of cerebrospinal fluid in the convexital space. Cerebral arachnoiditis on MRI in T2 mode

1. A clinical blood test makes it possible to determine the inflammatory process in the body and the presence of infection in it. It is also possible to identify an immunodeficiency state, that is, to detect the main causes of the development of the disease.
2. Radiography makes it possible to diagnose intracranial hypertension.
3. Consultation with an otolaryngologist is indicated for people with manifestations of hearing loss.
4. Lumbar puncture allows you to determine the level of intracranial pressure. In the case of development of cerebral arachnoiditis, it is possible to detect in the cerebrospinal fluid increased amount protein and neurotransmitters.

Only after comprehensive survey and an accurate diagnosis, the doctor will be able to prescribe the correct treatment.

Treatment

There are drug therapy for cerebral arachnoiditis and surgery. What the doctor chooses will depend on clinical manifestation diseases. The operation is performed in cases where the spinal cord, posterior cranial fossa, optochiasmatic region, surface of the cerebral hemispheres, or a cyst has been identified. For hydrocephalus, shunting is used. In all other cases, drug therapy is prescribed.

Use of medications

Treatment of cerebral arachnoiditis is always long-term and is prescribed in courses. For this, the patient is prescribed anti-inflammatory, hyposensitizing, dehydration and absorbable medications. If diagnosed acute period, treatment involves the use of antibiotics. The stages of treatment for arachnoid brain damage include:

• Prescribing antibiotics that will be effective for a specific infection (cephalosporins, penicillins, Kanamycin, etc.). The drugs are administered intramuscularly, intravenously or by the endolymphatic method (into the posterior cervical lymph nodes). For intramuscular administration, “Humizol” and “Biyoquinol” are used.
• In the case of an inflammatory process, treatment consists of the use of corticosteroids. Such drugs are prescribed in short courses. Prednisolone and Dexamethasone are mainly used. “Histoglobin” has a general strengthening effect. Its effectiveness has been proven in cases of brain damage due to allergies or infections.
• When the disease is accompanied by high ICP, Magnesium Sulfate, Lasix, Diacarb, Triampur, etc. are used for treatment. Diuretics are prescribed taking into account possible side effects and the presence of contraindications to their use.

• For treatment, internal iodine supplementation is prescribed.
• To improve the movement of cerebrospinal fluid and remove adhesions, the doctor will prescribe a procedure for blowing air into the space between the membranes of the brain.
• If a patient experiences epileptic seizures, treatment with antiepileptic drugs is indicated.
• For improvement cerebral circulation, prescribe vasodilating medications (“Cavinton”, “Cerebrolysin”, “Curantil”, “Vinpocetine”, etc.).

• Treatment may include the use of nootropics.
• To improve metabolic processes in the body, treatment allows taking vitamin preparations based on B vitamins, ascorbic acid, aloe extract, Aminalon, Cocarboxylase, etc.
• Fibrosing forms of the disease are treated with medications that promote the resorption of scars (Lidaza, Encephabol, etc.).
• Drugs with an antioxidant effect are prescribed.

Complementary therapy

Additional methods of treating cerebral arachnoiditis include:

1. Carrying out a lumbar puncture, which helps alleviate the condition of high ICP.
2. Psychotherapeutic rehabilitation.
3. Surgical treatment, during which the fusion sites of the brain membranes are separated, cysts and scars are removed.

The procedure for performing a lumbar puncture involves piercing the arachnoid membrane of the spinal cord between the 3rd and 4th, or 2nd and 3rd lumbar vertebrae with a Beer needle to collect cerebrospinal fluid.

The prognosis for the patient's life in most cases is favorable, however, the disease can contribute to disability. This leads to decreased vision and the occurrence of epilepsy attacks.

Arachnoiditis can be successfully treated today if you consult a doctor as early as possible and follow all his instructions. In this case, there is every chance of a full recovery and a return to a normal rhythm of life.