Tuberculous Arachnoiditis

Tuberculous arachnoiditis is a relatively common cause of myeloradiculopathy in countries endemic for tuberculosis. The inflammatory exudate surrounds, but does not infiltrate, the spinal cord and nerve roots. Frequently, there is vascular involvement with peri-arteritis and occlusion of small vessels. Neuronal structures are damaged by direct compression as well as by ischaemia. The changes of arachnoiditis may be focal, multifocal, or diffuse. In tuberculous arachnoiditis features of spinal cord or nerve root involvement may predominate but most often there is a mixed picture. Frequently, there is clinical evidence of multifocal radiculo myelopathy, but even when meningeal involvement is widespread, symptoms may arise from a single level. The hallmark of diagnosis is the characteristic myelographic picture, showing poor flow of contrast material with multiple irregular filling defects, cyst formation, and sometimes spinal block. Rarely, myelography may be normal. The CSF changes are those of chronic meningitis, frequently CSF sugar concentration is normal. Occasionally lumbar tap may be dry. These patients need adequate anti-tuberculous treatment for at least one year. The role of corticosteroids is uncertain, but there are several reports of apparently marked improvement following corticosteroid administration. If the patient does not respond to medical treatment, surgery may be required.

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Last date updated on April, 2024