Arachnoiditis treatment. Do people with cerebral arachnoiditis get accepted into the army? The course of the disease, its symptoms and consequences

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 can have an 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 subacute inflammatory process with his 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. This type is characterized by the presence of 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 of the disease 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

It is localized in the chiasmal region of the brain and can occur against the background of an infectious lesion of the paranasal sinuses, malaria, tonsillitis, syphilis, and also sometimes develops as a result of previous injuries (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. With the disease, hearing loss, disturbance of the vestibular apparatus, as well as damage to the facial, abducens and trigeminal nerves may be observed. 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 various localizations or previous trauma. The inflammatory process is predominantly localized along the posterior surface of the 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 an 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.

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 lacks its own vascular system. Signs of arachnoiditis in modern medicine referred to as serous meningitis.

Classification of the disease

Depending on location pathological process There are several types of disease. 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 of illness, 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 in various infectious diseases, develop due to inflammatory processes occurring in the middle ear and paranasal sinuses. Thus, causative 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. Often meets headache. 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 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 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. For getting additional information and excluding 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 speakers:

• lack of improvement after drug therapy;
• increase in intracranial hypertension;
• increase in focal symptoms;
• the presence of opticochiasmal 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 interfere with the normal circulation of 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, i.e. patients completely or partially lose the ability or ability to carry out the main components 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 parts or perform their professional duties that require eye 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, the light is too bright.

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 is also 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. If there are suspicious symptoms, various tests are prescribed. Also carried out differential diagnosis, because many diseases have a similar clinical picture(eg, brain tumors, normal pressure hydrocephalus, neurosarcoidosis, multiple sclerosis, idiopathic epilepsy).

- This nervous system disease, in which there is inflammation of the soft membrane of the brain or spinal cord with predominant defeat arachnoid ( arachnoid) shells. Isolated lesion of the arachnoid membrane ( true arachnoiditis) cannot be, since it lacks its own circulatory network. The long course of this pathology in the absence of treatment can lead to the formation of adhesions ( adhesions, septa) and cysts ( cavity with contents). Arachnoiditis most often occurs in children and adults ( more often in men) up to 40 years.

The following types of arachnoiditis are distinguished:

• cerebral arachnoiditis– is an inflammation of the soft membrane surrounding the brain;
• spinal arachnoiditis– is an inflammation of the soft membrane surrounding the spinal cord.

The following types of cerebral arachnoiditis are distinguished:(depending on location):

• convexital arachnoiditis– is an inflammation of the arachnoid membrane in the cerebral hemispheres, which is accompanied by a violation of neurological symptoms ( seizures, sensory disturbances);
• basal arachnoiditis– is an inflammation of the arachnoid membrane at the base of the brain and is manifested by damage cranial nerves, visual impairment and some metabolic processes;
• optochiasmal arachnoiditis– is a type of basal arachnoiditis and is accompanied by various visual impairments ( decreased visual acuity and narrowing of visual fields) and color perception ( especially the perception of red and green colors);
• Arachnoiditis of the cerebellopontine angle– is a type of basal arachnoiditis and is accompanied by headache ( in the occipital region), dizziness, tinnitus, vomiting, as well as damage to the facial nerve;
• arachnoiditis of the posterior cranial fossa– accompanied by damage to the cranial nerves, impaired coordination of movements ( staggering when walking), headaches, impaired circulation of cerebrospinal fluid.

The following types of arachnoiditis are distinguished:(according to the mechanism of occurrence):

• adhesive arachnoiditis– is an inflammation of the arachnoid membrane of the brain, in which adhesions are formed ( fusions), leading to disruption of the circulation of cerebrospinal fluid and the appearance of severe headaches;
• cystic arachnoiditis- is an inflammation of the arachnoid membrane of the brain, in which cavities are formed ( cysts);
• adhesive cystic arachnoiditis– develops as a result of inflammation of the membranes of the brain and their adhesion, with cysts forming between the areas of adhesion.

The meninges are special membranes that cover the brain ( main organ of the central nervous system). These structures are located in the cranial cavity and separate the brain from the inner surface of the skull. There are outer, middle and inner membranes of the brain. These membranes also surround the spinal cord.

Outer shell

Outer meninges ( hard) is a dense whitish formation. It consists of an outer and inner surface. The outer surface fits tightly to the bones of the skull. Inner surface is smooth, shiny and facing the medial shell. The inner surface forms several processes that pass into the deep crevices of the brain. The thickness of the outer shell varies and depends on what part of the brain it covers. Dura shell, covering top part brain, has 0.7 - 1 mm. Hard shell covering bottom part brain, is 0.1 - 0.5 mm. In some places it has splits ( bifurcation), which are called sines ( venous sinuses). In these formations occurs deoxygenated blood.

Middle shell

Middle meninges ( arachnoid, arachnoid) is one of three membranes that covers the brain and spinal cord and is a thin ( in the form of a web), transparent education. It is located between the other two meninges– dura mater and pia mater. Many branching fibers in the form of threads extend from the arachnoid membrane ( trabeculae). These structures are woven into the pia mater, which is located under the arachnoid membrane. On both sides, the middle meninges are covered with nerve cells ( glial cells). The space located between the outer and middle membranes is called the subdural space. It contains a special liquid ( cerebrospinal fluid). This liquid is a nutrient medium for the brain. Unlike the dura mater, the arachnoid membrane does not penetrate into the fissures of the brain. It does not contain blood vessels.

Inner shell

Inner shell ( vascular, soft) is a structure that is located between the arachnoid membrane and the surface of the brain. It penetrates into all its cracks and furrows. The inner shell contains a large amount blood vessels that supply blood to the brain. The space located between the arachnoid and choroid, called subarachnoid ( subarachnoid) space. It contains approximately 120–140 ml of cerebrospinal fluid. In some places, this space forms significant expansions, which are called tanks.

The following functions of the meninges are distinguished:

• protective ( barrier) function– is the main function of the meninges, which provides protection to the brain from mechanical damage;
• circulatory function– meninges promote blood circulation and nutrition of the brain;
• restrictive function– Separates parts of the brain from each other.

What happens in the arachnoid membrane of the brain during inflammation?

With inflammation of the arachnoid membrane of the brain, significant changes in its structure are observed. These changes occur under the influence of pathological microorganisms ( bacteria, viruses) and the harmful substances they emit ( toxins). The listed factors lead to damage to the structure of the middle meninges. In response to damage, special substances, so-called inflammatory mediators, begin to be released. Under their influence, the arachnoid membrane thickens and becomes much denser. It loses its transparency and becomes cloudy. Gradually, adhesions appear between the arachnoid, soft or hard membranes ( fusions). These formations interfere with normal movement ( circulation) cerebrospinal fluid. In addition, under the influence of the inflammatory process, cerebrospinal fluid is formed in large quantities ( in excess). This liquid begins to stagnate. As a result of this process, bubbles are formed ( arachnoid cysts) of various sizes. At first they contain a clear liquid, which then becomes cloudy. These cysts become denser over time. They begin to put pressure on the brain and irritate its structures. These changes lead to significant consequences, which are manifested by impaired brain function.

Another mechanism for the formation of arachnoiditis is autoimmune influence. IN in this case the body attacks own cells, including the cells of the membranes of the brain. Under the influence of autoimmune processes, special structures are formed ( antibodies), the action of which is directed against the cells of the arachnoid membrane. As a result, swelling of the pia mater occurs. The channels through which cerebrospinal fluid flows are closed. This fluid accumulates and puts pressure on the structures of the brain. As a result of these pathological processes, a corresponding clinical picture of a disease such as arachnoiditis arises.

Causes of arachnoiditis

Various past infections can contribute to the development of arachnoiditis ( acute or chronic), inflammatory diseases of the ENT organs ( ear, throat, nose), injuries. In 10% of cases, it is not possible to establish the exact cause of arachnoiditis. Factors contributing to the development of this pathology include various poisonings ( intoxication with lead, arsenic, alcohol), constant overwork, hard physical labor in unfavorable conditions.

Causes of arachnoiditis

How is arachnoiditis treated for various pathologies?

Treatment of arachnoiditis can be medicinal or surgical and is usually carried out in a hospital ( in the hospital) in the Department of Neurology. The choice of treatment method depends on the cause of the disease and the degree of its activity ( manifestation of symptoms). Due to the fact that the clinical symptoms of the disease begin to appear after quite a big gap time after exposure to the provoking factor, treatment should be aimed at improving general condition and elimination of symptoms that bother the patient at the moment. Particular attention must be paid to preventing the progression of the disease and preventing the development possible complications. In case of complicated arachnoiditis ( progressive vision loss, hydrocephalus) can be shown surgical intervention. For adhesive arachnoiditis, absorbable drugs are prescribed ( lidase, rumalon, pyrogenal). When convulsive attacks develop, they are treated with anticonvulsants ( phenobarbital). If the patient has an increase in intracranial pressure, diuretics may be prescribed that promote the excretion excess liquid from the body.

Treatment of arachnoiditis

Traditional methods of treating arachnoiditis can be used in combination with drug treatment for uncomplicated disease. Arachnoiditis is a disease of the nervous system that requires consultation with a specialist and selection of appropriate treatment tactics. Before starting treatment folk remedies It is necessary to consult a doctor, since in addition to the beneficial properties, there are also contraindications that can aggravate the patient’s general condition. In case of severe arachnoiditis and the presence of complications traditional methods treatments will be ineffective. If there is no effect from treatment with folk remedies or if any adverse reactions occur, it is also necessary to urgently consult a doctor to prescribe adequate treatment.

Lavender and honey

It is necessary to collect lavender flowers ( reddish color) and fill the jar with them. The filled jar with flowers is filled with honey and left to infuse for 6 months in a cool, dark place. It is necessary to stir the contents periodically. After six months, the resulting mixture is taken one tablespoon three times a day. Lavender relieves vasospasm, helps reduce headaches, and helps with cramps. Honey has an anti-inflammatory effect and helps improve immunity.

St. John's wort, sage and motherwort

To prepare this collection, you need to mix St. John's wort, sage and motherwort in equal proportions. After this, one tablespoon of the collection is poured with one liter of boiling water and left overnight ( in a thermos). In the morning you need to drink one glass of the resulting infusion. Drink the rest throughout the day. The course of treatment lasts one month. Then they take a break for several months and repeat the course. St. John's wort has anti-inflammatory and antispasmodic ( relieves spasm) action. Sage and motherwort have anti-inflammatory and antiseptic properties ( disinfecting) properties. Motherwort also helps remove excess fluid from the body, thereby reducing blood pressure.

Parsley root

You need to dry the parsley root and then grind it to a powder. One teaspoon of parsley powder is poured into a glass of boiling water and taken 3 times a day, 1/3 cup with meals. Parsley root has anti-inflammatory, disinfectant ( antiseptic), bactericidal ( ), analgesic, anticonvulsant, restorative effect.

Lemon, garlic and honey

For cooking this tool you need to mince the lemon ( 5 items) and garlic ( 5 medium heads). Then mix and add about 500 grams of honey. The resulting product is taken four teaspoons after meals three times a day. Lemon, garlic and honey are bactericidal ( destroys pathogenic bacteria) properties and strengthens immune system.

Fir oil

Fir oil can help with cerebral arachnoiditis. It is necessary to rub the oil into the temples, forehead, crown and around the ears. After application to the skin, a slight tingling sensation may be felt for several minutes. Fir oil has anti-inflammatory, bactericidal ( destroys pathogenic bacteria), analgesic properties, and also has a general strengthening effect, increasing the body's defenses. The course of treatment lasts one month.

Aloe, elecampane, honey and wine

To prepare this decoction you will need aloe leaves ( 150 grams), elecampane root ( 50 grams), Bee Honey (500 grams) and red wine ( 2 liters). First, you need to prepare a paste from aloe leaves, which is then mixed with elecampane roots. After this, add bee honey and wine, mix and cook in a water bath for one hour. Before use, strain the decoction and take 1-2 tablespoons before meals ( 20 minutes before meals) 3 times a day. All ingredients have a healing effect and have an anti-inflammatory, strengthening effect.

Prevention of arachnoiditis is a complex medical task and consists in preventing the development of this pathology and possible complications. Since arachnoiditis can develop against the background various diseases, intoxications and injuries - it is necessary to prevent their occurrence and promptly eliminate the provoking factor.

Distinguish following methods prevention of arachnoiditis:

• maintaining a healthy lifestyle ( hardening, increasing immunity);
• regularly visiting a doctor for a medical examination;
• early diagnosis and timely treatment infectious diseases;
• prevention of infectious diseases ( avoid contact with infected people, vaccinate children);
• timely treatment of inflammatory diseases of the ENT organs ( ear, throat, nose);
• increased caution when engaging in dangerous sports or while in a car in order to prevent traumatic brain injury;
• prevention of arachnoiditis with existing risk factors;
• timely prevention of relapse ( re-development of the disease).

Do people with cerebral arachnoiditis get accepted into the army?

The diagnosis of cerebral arachnoiditis established by a neurologist is a serious reason for declaring a person unfit for military service. As a rule, patients with such a diagnosis are assigned a disability group. The disability group is assigned depending on clinical symptoms and complications that may arise due to arachnoiditis. Such complications include the development of hydrocephalus ( excess fluid accumulation in the brain), the occurrence of frequent epileptic ( convulsive) attacks, decreased visual acuity up to the development of blindness. Military service requires physical and mental health. The above complications can only aggravate the course of cerebral arachnoiditis and lead to irreversible consequences.

Initially, cerebral arachnoiditis may manifest itself increased fatigue, weakness, irritability, sleep disturbances. Against the background of this condition, seizures may develop ( epileptic seizures ). Subsequently, the disease progresses, and patients begin to feel a constant headache, pain in the eyes, and tinnitus. Often cerebral arachnoiditis leads to disruption of the normal circulation of cerebrospinal fluid ( liquor), which may manifest as sudden onset of headache, dizziness, nausea and vomiting.

Depending on the location ( location) of cerebral arachnoiditis, clinical manifestations can be very diverse. This disease may interfere with physical activity (coordination of movements) and sensitivity in one or both lower limbs. Impaired memory, attention, and decreased mental performance may also occur. Some forms of cerebral arachnoiditis lead to a progressive decrease in visual acuity and hearing loss. Such patients are prohibited from serving in the army, since any unfavorable conditions ( climate, physical or emotional stress) can provoke a deterioration in the patient’s general condition. Patients with cerebral arachnoiditis need to be regularly examined by a neurologist in order to stop the progression of the disease in time and prevent the development of severe complications. As a rule, patients who have been diagnosed with arachnoiditis undergo a VTEC commission ( medical labor expert commission), which establishes the presence of the disease, the reasons for its development and the degree of disability. Accordingly, such patients cannot serve in the army.

What can be the consequences of cerebral arachnoiditis?

If left untreated, cerebral arachnoiditis may develop severe complications. The most severe cases of this pathology are considered to be paresis or paralysis, the development of hydrocephalus, epilepsy and blindness.

Paralysis is complete absence arbitrary ( independent) movements, loss of motor functions. Paresis is an incomplete loss of motor functions and a decrease in muscle strength. These complications arise against the background of spinal arachnoiditis, when nerve structures are involved in the process. This may be due to injury to the spinal cord and its membranes in some diseases ( spondylosis, osteochondrosis), tumors, after repeated manipulations near the spine ( epidural block, lumbar puncture).

Hydrocephalus is an excessive accumulation of cerebrospinal fluid ( cerebrospinal fluid) in the brain. One of the reasons for the accumulation of fluid is a violation of its outflow due to the presence of adhesions ( adhesions) or cysts ( cavities), which can form with cerebral arachnoiditis. Another reason is excess secretion ( production) cerebrospinal fluid and impaired absorption ( absorption). With the development of hydrocephalus, intracranial pressure increases, and visual acuity gradually decreases. Hydrocephalus is also accompanied by constant headaches ( especially in the morning), nausea, vomiting ( bringing no relief). If this condition lasts for a long time and there is no necessary treatment pressure is exerted on brain structures, which can lead to death.

Epilepsy is a disease of the nervous system ( brain), which is characterized by the occurrence sudden attacks seizures ( epileptic seizures) and may be accompanied by loss of consciousness and foaming from the mouth. The development of this complication most often occurs with inflammation of the arachnoid membrane in the area of ​​the cerebral hemispheres, that is, with convexital arachnoiditis. The triggering mechanism for the occurrence of epilepsy attacks can be recent brain injuries. It is necessary to conduct a thorough diagnosis, since in some cases epileptic seizures may not be associated with the development of arachnoiditis.

Blindness is total loss vision, inability to see. This complication occurs, as a rule, with opticochiasmatic arachnoiditis, when the optic nerve is damaged. Initially, with opticochiasmatic arachnoiditis, there is a gradual decrease in vision, narrowing of the visual fields, eye fatigue, and impaired color perception ( It is especially difficult to distinguish between red and green colors). In the absence of timely and adequate treatment, visual impairment progresses and can lead to the development of complete blindness.

How does spinal arachnoiditis manifest?

With spinal arachnoiditis, inflammation of the arachnoid membrane of the spinal cord occurs. Clinical manifestations ( symptoms) diseases appear after a certain period of time ( in a few months or more) after exposure to a provoking factor on the body ( disease, intoxication, injury). This pathology is characterized by pain in the spine at the level of the pathological process ( chest, lumbar region ). At first, the pain is periodic, and then the patient feels it constantly. The first symptoms of spinal arachnoiditis are sensory disturbances in the limbs, weakening of tendon reflexes ( muscle contraction in response to stimulation). The patient may feel weakness and tingling in the legs, shooting pains. Sometimes the patient may feel numbness, muscle spasms ( spontaneous twitching) in the lower extremities. In some cases, dysfunction of the pelvic organs may occur.

IN acute period diseases, spinal arachnoiditis, in addition to the above symptoms, can be manifested by high fever, changes in the blood and cerebrospinal fluid characteristic of inflammation ( liquor).

Spinal arachnoiditis can be combined with cerebral arachnoiditis. In this case, the clinical manifestations will depend on the location ( localization) pathological focus and prevalence of the inflammatory process along the arachnoid membrane. Gradually developing symptoms spinal arachnoiditis, if untreated, disrupts the usual way of life and leads to disability. It is very important to be examined in time, identify all symptoms and begin treatment for early stage diseases.

How does arachnoiditis manifest in children?

Clinical manifestations ( symptoms) arachnoiditis in children depend on the location ( location) pathological process. For cerebral arachnoiditis ( cerebral arachnoiditis) is characterized by the appearance of pain in the back of the head, back of the neck and pain in the eyes. Also, with this pathology, children complain of rapid fatigue, a constant feeling of weakness and heaviness in the head. On the background elevated temperature headache, nausea, vomiting, dizziness appears. In severe cases, there is a progressive decrease in visual acuity ( up to complete blindness), convulsions, loss of consciousness. Spinal arachnoiditis is characterized by the development of pain at the level of injury, sensory impairment and motor impairment.

Symptoms of arachnoiditis appear after a long period of time after exposure to the provoking factor and are complications of the underlying disease. This could be a few months later ( after infectious diseases) or even several years ( after suffering a traumatic brain injury). At the very beginning, the disease may manifest itself as fatigue, constant irritability ( psycho-emotional disorders) and memory impairment. The child is disturbed healthy sleep, and seizures of epilepsy may occur ( seizures). With a significant severity of the process and a long course of the disease in young children ( from 1 year to 3 years) mental retardation may occur.

In the subarachnoid space ( between the pia mater and the arachnoid mater) due to inflammatory changes, adhesions are formed ( fusions). In other cases, cysts may form ( cavities) of various sizes. All these changes disrupt the circulation of cerebrospinal fluid ( liquor) and lead to increased intracranial pressure ( intracranial hypertension).

Is disability assigned to those suffering from arachnoiditis?

Depending on the clinical manifestations, patients suffering from arachnoiditis are assigned a certain disability group. This is due to the fact that this pathology can cause disability. Disability is assigned to patients who experience frequent relapses ( return of the disease after apparent recovery), epileptic seizures ( convulsions), vision deterioration progresses.

The following disability criteria are distinguished:

• 3 disability group– assigned to patients whose production activity decreases when transferred to easier work. Such patients need changes in working conditions due to the occurrence of hypertensive syndrome ( persistent increase in intracranial pressure).
• Disability group 2– assigned to patients who have progression of the disease, frequent exacerbations, persistent visual impairment ( decreased acuity and narrowing of visual fields). Also in such patients one can observe the frequent development of epileptic ( convulsive) seizures, vestibular dysfunction ( coordination of movements).
• 1st disability group– assigned to patients who develop complete blindness or a significant decrease in hearing, visual acuity and a sharp narrowing of visual fields. At the same time, patients cannot do without outside help, there is a limitation in the ability to navigate in space and self-service.

Patients with an established diagnosis of arachnoiditis are prohibited from physical and neuropsychic stress. Also, patients are contraindicated from working in unfavorable conditions ( noise, vibration, contact with toxic substances, changed atmospheric pressure). Some patients ( with attacks of convulsions, attacks of incoordination of movements) It is prohibited to work near moving mechanisms, at heights, or near fire. If the patient has impaired vision, work that involves eye strain or requires clear distinction of colors is contraindicated.

Every year, patients who have been assigned a disability group must undergo re-examination. In case of persistent and irreversible visual impairment, after a five-year observation, the disability group is established without specifying the period for re-examination. In case of positive changes in the dynamics of the disease, a change in the disability group is possible.

Why is smoking dangerous for arachnoiditis?

Smoking with arachnoiditis leads to aggravation of the patient’s condition and irreversible changes in the brain. Nicotine contained in cigarettes affects not only the organs respiratory system, but also on organs that are damaged. In this case, such an organ is the brain, or rather its membranes. 8–10 seconds after starting smoking, nicotine reaches the brain, where it begins to have its harmful effects. Smoking leads to spasms ( narrowing) cerebral vessels. This leads to an additional increase in intracranial pressure, which is already present in arachnoiditis due to the formation of adhesions ( adhesions) and disturbances in the circulation of cerebrospinal fluid. Also, when smoking, blood circulation is impaired, which leads to impaired oxygen delivery and, accordingly, insufficient oxygen supply to the brain. Since the cells of the nervous system are the most sensitive to a lack of oxygen, they are the first to react to such changes, which leads to hypoxia ( oxygen starvation). For a long time oxygen starvation Intense headaches, memory impairment, and impaired coordination of movements develop. Since these symptoms are observed with arachnoiditis even without smoking, their manifestation is even more pronounced in smokers.

Long-term smoking leads to impaired elasticity of the walls of blood vessels. They become less elastic and weak. Increases the likelihood of cholesterol deposits ( atherosclerotic plaques) on the walls of blood vessels, which will further aggravate the blood supply to the brain. Smoking is a powerful poison that has toxic effects not only on the brain, but also on other organs. In smokers with brain pathology ( cerebral arachnoiditis) symptoms of the underlying disease appear in to a greater extent, the disease is progressing. More frequent development of complications and less effective results of treatment were noted.

Autoimmune inflammatory damage to the arachnoid membrane of the brain, leading to the formation of adhesions and cysts in it. Clinically, arachnoiditis is manifested by liquor-hypertension, asthenic or neurasthenic syndromes, as well as focal symptoms (damage to cranial nerves, pyramidal disorders, cerebellar disorders), depending on the predominant localization of the process. The diagnosis of arachnoiditis is established on the basis of anamnesis, assessment of the patient’s neurological and mental status, data from echo-EG, EEG, lumbar puncture, ophthalmological and otolaryngological examination, MRI and CT of the brain, CT cisternography. Arachnoiditis is treated mainly with complex drug therapy, including anti-inflammatory, dehydration, antiallergic, antiepileptic, absorbable and neuroprotective drugs.

General information

Arachnoiditis of the posterior cranial fossa often has a severe course, similar to brain tumors of this location. Arachnoiditis of the cerebellopontine angle, as a rule, begins to manifest itself as a lesion auditory nerve. However, it may begin with trigeminal neuralgia. Then symptoms of central neuritis of the facial nerve appear. With arachnoiditis of the cistern magna, a pronounced liquor-hypertensive syndrome with severe liquor-dynamic crises comes to the fore. Cerebellar disorders are characteristic: coordination disorders, nystagmus and cerebellar ataxia. Arachnoiditis in the area of ​​the cistern magna can be complicated by the development of occlusive hydrocephalus and the formation of a syringomyelitic cyst.

Diagnosis of arachnoiditis

A neurologist can establish true arachnoiditis only after comprehensive survey patient and comparison of anamnestic data, neurological examination results and instrumental studies. When collecting anamnesis, pay attention to gradual development symptoms of the disease and their progressive nature, recent infections or traumatic brain injuries. A study of the neurological status makes it possible to identify disorders of the cranial nerves, determine focal neurological deficits, psycho-emotional and mnestic disorders.

Lumbar puncture provides accurate information about the amount of intracranial pressure. Examination of the cerebrospinal fluid in active arachnoiditis usually reveals an increase in protein to 0.6 g/l and the number of cells, as well as increased content neurotransmitters (eg serotonin). It helps differentiate arachnoiditis from other cerebral diseases.

Treatment of arachnoiditis

Treatment for arachnoiditis is usually carried out in a hospital. It depends on the etiology and degree of disease activity. The drug treatment regimen for patients with arachnoiditis may include anti-inflammatory therapy with glucocorticosteroid drugs (methylprednisolone, prednisolone), absorbable agents (hyaluronidase, quinine iodobismuthate, pyrogenal), antiepileptic drugs (carbamazepine, levetiracetam, etc.), dehydration drugs (depending on the degree of increase intracranial pressure - mannitol, acetazolamide, furosemide), neuroprotectors and metabolites (piracetam, meldonium, ginkgo biloba, pig brain hydrolysate, etc.), antiallergic medications (clemastine, loratadine, mebhydroline, hifenadine), psychotropics (antidepressants, tranquilizers, sedatives) . An obligatory point in the treatment of arachnoiditis is the sanitation of existing foci of purulent infection (otitis media, sinusitis, etc.).

Arachnoiditis is an inflammation of the soft membrane of the brain or spinal cord with predominant damage to the arachnoid membrane.

Classification. According to the predominant localization, arachnoiditis is distinguished on the convex surface of the cerebral hemispheres (convexital), base of the brain (basal), optochiasmatic (in the area of ​​the optic chiasm), cerebellopontine angle and posterior cranial fossa; according to the course – subacute and chronic.

Etiology. Polyetiological disease: causative factors are influenza, rheumatism, chronic tonsillitis, rhinosinusitis, otitis, common infections(measles, scarlet fever), previous meningitis and traumatic brain injury.

Pathogenesis. The leading role is played by autoimmune and autoallergic reactions to antigens of the soft membrane, choroid plexus and ventricular ependyma with predominantly proliferative changes in them in response to various damaging factors.

Pathomorphology. Cloudiness and thickening of the arachnoid membrane, connective tissue adhesions, and sometimes cysts filled with clear or turbid liquid are detected. There are widespread and limited, adhesive, cystic and cystic adhesive arachnoiditis.

Clinical manifestations. The disease develops subacutely with the transition to a chronic form. Clinical manifestations are a combination of general cerebral disorders, more often associated with intracranial hypertension, less often with liquor hypotension, and symptoms reflecting the predominant localization of the meningeal process. Depending on the predominance of common or local symptoms the first manifestations may be different. Among the general cerebral symptoms, headache is common, most intense in the early morning hours and sometimes accompanied by nausea and vomiting. The headache can be local, aggravated by straining, straining or awkward movement with firm support on the heels (a symptom of jumping is a local headache when jumping with an unabsorbed descent on the heels). General cerebral symptoms also include dizziness of a non-systemic nature, memory loss, irritability, general weakness and fatigue, and sleep disturbances.

Focal symptoms depend on the location of arachnoiditis. Convexital arachnoiditis is characterized for the most part by a predominance of the phenomena of brain irritation over signs of loss of function. One of the leading symptoms is generalized and Jacksonian epileptic seizures. With basal arachnoiditis, general cerebral symptoms and dysfunction of the nerves located at the base of the skull are observed. Reduced acuity and changes in visual fields can be detected with optochiasmatic arachnoiditis. Clinical manifestations and fundus patterns may resemble symptoms of neuritis optic nerve. These manifestations are often accompanied by symptoms autonomic dysfunction(severe dermographism, increased pilomotor reflex, profuse sweating, acrocyanosis, sometimes thirst, increased urination, hyperglycemia, adiposisogenital obesity). In some cases, a decrease in sense of smell may be detected. Arachnoiditis in the area of ​​the cerebral peduncles is characterized by the appearance of pyramidal symptoms, signs of damage oculomotor nerves, meningeal signs. With arachnoiditis of the cerebellopontine angle, headaches in the occipital region, noise in the ear and paroxysmal dizziness, and sometimes vomiting occur. The patient staggers and falls towards the affected side, especially when trying to stand on one leg. An ataxic gait, horizontal nystagmus, and sometimes pyramidal symptoms, dilation of veins in the fundus as a result of impaired venous outflow. Symptoms of damage to the auditory, trigeminal, abducens and facial nerves. Arachnoiditis of the large (occipital) cistern develops acutely, the temperature rises, vomiting, pain in the back of the head and neck appears, aggravated by turning the head, sudden movements and coughing; damage to the cranial nerves (IX, X, XII pairs), nystagmus, increased tendon reflexes, pyramidal and meningeal symptoms. With arachnoiditis of the posterior cranial fossa, damage to the V, VI, VII, VIII pairs of cranial nerves is possible. Intracranial hypertension, cerebellar and pyramidal symptoms are often observed. Differential diagnosis with tumors of the posterior cranial fossa is mandatory. Lumbar puncture is performed only in the absence of congestion in the fundus.

Diagnosis and differential diagnosis. The diagnosis should be based on a comprehensive assessment of the clinical manifestations and characteristics of the course of the disease, as well as additional research methods. It is necessary to first rule out a brain tumor. On survey craniograms with cerebral arachnoiditis, indirect signs of intracranial hypertension are possible. The EEG with convexital arachnoiditis reveals local changes in biopotentials, and in patients with epileptic seizures - changes typical for epilepsy. In the cerebrospinal fluid, moderate lymphocytic pleocytosis and sometimes slight protein-cell dissociation are detected. Liquid flows out under increased pressure. Crucial in the diagnosis of arachnoiditis are brain tomography data (CT and MRI), indicating an expansion of the subarachnoid space, ventricles and cisterns of the brain, sometimes cysts in the intrathecal space, in the absence of focal changes in the brain substance.

Data from CT and MRI studies are of great importance in excluding other organic diseases. Arachnoiditis should be differentiated from a brain tumor. With arachnoiditis, the disease begins subacutely after infection or exacerbation of the process in paranasal sinuses nose, purulent otitis and occurs in remissions. The results of echoencephalography, angiography and scintigraphy are informative, but, as a rule, the data computed tomography are of decisive importance. Differential diagnosis between arachnoiditis and cysticercosis based on clinical symptoms alone is not always easy. When the cysticercus is localized in the ventricles of the brain, membrane symptoms are observed: vomiting, headache; periodic improvement is replaced by drowsiness (remitting course), moderate pleocytosis is detected in the cerebrospinal fluid as a manifestation of irritation of the membranes or ependyma of the ventricles, eosinophilia is noted in the blood. Informative additional methods studies: for example, radiographs of the skull and muscles of the extremities may reveal calcified cysticerci.

Treatment. It is necessary to eliminate the source of infection (otitis media, sinusitis, etc.). Antibiotics are prescribed in therapeutic doses. Desensitizing and antihistamines(diphenhydramine, diazolin, suprastin, tavegil, pipolfen, calcium chloride, histaglobulin). Pathogenetic therapy is designed for long-term course treatment with absorbable agents, normalization of intracranial pressure, improvement of cerebral circulation and metabolism. Biogenic stimulants are used (aloe, vitreous, FiBS) and iodide preparations (biyoquinol, potassium iodide). Lidase is also used in the form of subcutaneous injections of 0.1 g of dry matter, dissolved in 1 ml of 0.5% novocaine solution every other day, for a course of 15 injections. The courses are repeated after 4–5 months. Pyrogenal has a resolving effect. First intramuscular injections pyrogenal is started with a dose of 25 MTD, in subsequent days the dose is increased daily by 50 MTD and brought to 1000 MTD; for a course of treatment up to 30 injections. When intracranial pressure increases, decongestants and diuretics are used (mannitol, furosemide, diacarb, glycerin, etc.). For convulsive syndromes, antiepileptic drugs are used. Conduct metabolic therapy ( glutamic acid, piracetam, aminalon, cerebrolysin). Symptomatic agents are used according to indications. Lack of improvement after treatment, increase in intracranial pressure and focal symptoms, opticochiasmatic arachnoiditis with a steady decrease in vision are indications for surgical intervention.

Forecast. In relation to life, usually favorable. Arachnoiditis of the posterior cranial fossa with occlusive hydrocephalus may pose a danger. The labor prognosis worsens with frequent relapses or a progressive course with frequent hypertensive crises, epileptic seizures, with the optic chiasmatic form.

Work ability. Patients are recognized as disabled group III if employment or transfer to light work leads to a decrease in the volume of production activities. Group II disability is established in the presence of frequent epileptic seizures, a significant decrease in visual acuity in both eyes (from 0.04 to 0.08 with correction). Group I disabilities are patients with optochiasmatic arachnoiditis, accompanied by blindness. Patients with liquorodynamic disorders, epileptic seizures and vestibular crises are contraindicated from working at heights, near fire, near moving machinery, or in transport. Work in adverse weather conditions, in noisy rooms, in contact with toxic substances and in conditions of changed atmospheric pressure, as well as work associated with constant vibration and changes in head position are contraindicated.