Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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February 2, 2017
Intracranial Adhesive Arachnoiditis
- Background:
- Intracranial adhesive arachnoiditis is an extremely rare pathology with few cases and minimal literature or imaging discussion.
- Similar etiology and manifestation as spinal adhesive arachnoiditis
- Pathogenesis is acute inflammation of the dura and arachnoid membranes. The inflammation is followed by scarring and fibrosis, which cause the adhesions.
- Most commonly caused by infections (meningitis), but can also occur secondary to subarachnoid hemorrhage or other causes of meningeal irritation, such as multiple epidural injections, trauma, radioactive thorium dioxide contrast, tuberculosis, neurocysticercosis, or sarcoidosis
- Clinical Presentation:
- Can present with chronic headaches, neuropathic pain, cranial nerve deficits, or increased intracranial pressure
- Key Diagnostic Features:
- Cerebral spinal fluid loculations from the adhesions in the extra-axial spaces and ventricular system in light of a history of prior meningeal irritation
- Differential Diagnoses:
- Meningitis: inflammation can irritate meninges, causing scarring, fibrosis, and ultimately adhesions
- Trauma: can be an etiology of meningeal inflammation
- Neurocysticercosis: can cause subarachnoid cysts, which can mimic the CSF loculations caused by adhesive arachnoiditis
- Prior colloidal thorium dioxide (Thorotrast) ventriculography: thorotrast, an old contrast agent used in the 1930s and 1940s, has been reported as a cause of intracranial chronic arachnoiditis
- Treatment:
- Symptom control
- Ventriculostomy for CSF shunt if increased intracranial pressure
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