Tuberculous Arachnoiditis
In tuberculosis-endemic countries,
tuberculous arachnoiditis is a fairly common cause of myeloradiculopathy. The inflammatory
spinal cord and nerve roots surround, but do not penetrate. Periarteritis and occlusion of small arteries are frequently caused by vascular involvement. Direct compression and
ischemia damage neuronal structures. Arachnoiditis shifts may be intense, multifocal or diffuse. Tuberculous arachnoiditis can dominate the function of the
spinal cord or nerve root, but there is a mixed picture most often. Often clinical evidence of multifocal reticulum myelopathy is present, but symptoms may occur from a single level even when meningeal involvement is widespread. The characteristic myelographic pictorial characteristic of diagnosis shows poor flow of contrast material with multiple defects in the filling, formation of a cyst and, occasionally, spinal blocks. Myelography can seldom be normal. The patients need to be treated properly for at least one year with anti-tuberculosis. The role of
corticosteroids is uncertain, but after the
administration of
corticosteroids there are many reports of apparently significant improvements. Operation may be required if the patient does not react to medical treatment.
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