UpdateSpinal adhesive arachnoiditis following the rupture of an Adamkiewicz aneurysm: Literature review and a case illustration
Section snippets
Abbreviations
- SAA
spinal adhesive arachnoiditis
- SAH
subarachnoid haemorrhage
- SSAH
spinal subarachnoid haemorrhage
- AVM
arteriovenous malformation
- CSF
cerebrospinal fluid
- CT scan
computerized tomography scan
- MRI
magnetic Resonance Imaging
- RCT
randomized controlled trials
- DSA
Digital Subtraction Angiography
Patients and methods
The literature review was performed via a PubMed search using the following keywords.
Adhesive arachnoiditis, Spinal subarachnoid haemorrhage, Spinal arachnoiditis, spinal arachnoid cyst, arachnoid cyst, the search yielded a total of 24 articles.
Due to the presence of only a few reported studies on this subject, we decided to include all studies reporting cases of adhesive arachnoiditis after a subarachnoid haemorrhage leading to a descriptive literature review. Descriptive statistics of the
Population
Twenty-four case reports [1], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34] were found regarding SAA following a SSAH. Thirty-four patients, including the present case, were described, 23 were women and 7 were men (in 2 studies, in 4 patients, the age and sex of the patients, was not stated). The mean age was 57 years (range 22–73 years) all the results are summarised on Table 1.
Although location of the
Case illustration
A 57 year-old man with no significant past medical history presented at a peripheral hospital with sudden and severe epigastric pain associated with back pain and signs of meningeal irritation. A few hours later the patient developed diffuse lower limb paraesthesia. An urgent head CT-scan revealed a peri-mesencephalic SAH.
A subsequent cerebral DSA was normal. The patient underwent further examinations and a spine MRI showed a round intra-dural lesion anterior to the spinal cord at the level of
Overview
First reported in 1943 [36] SAA is an extremely rare complication of SAH which can occur months to years after the causative event [1], [14], [30]. Other causes of inflammation of the pial-arachnoid membrane include: meningitis [37], spinal trauma and intra-thecal injections [3], [4].
Morphological and clinical aspects
Regarding the most frequent thoracic localisation of SAA, we can speculate that the former is related to the intrinsic anatomical configuration of this region being the size of the canal relatively smaller than the
Conclusion
Spinal adhesive arachnoiditis is rare and a recognised consequence of SAH. It can occur under many conditions, surprisingly, even in cerebral anterior circulation aneurysm bleeding. It appears to be associated with a better outcome if located in the cervical levels. Early identification seems to have a positive impact on outcome and treatment by laminectomy, microadhesiolysis and eventually shunting as the most often reported strategy and seems to be associated with neurological improvement or
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Role of funding and source
No funding was received for this research.
Disclosure of interest
The authors declare that they have no competing interest.
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