Infectious diseases of various etiologies andlocalization after its generalization is dangerous not only from the general intoxication, but also as a cause of inflammation of the lining of the brain. As a rule, patients think a little about this, and doctors can miss the harbingers of complications.
Definition
Arachnoiditis is an inflammation of the arachnoidspinal cord or brain. Such a division is arbitrary, since isolated forms are not found in clinical practice. This is due to the structure of the vascular system. The infection spreads from the dura or pia mater, so arachnoiditis can be compared with serous meningitis.
The term "brain arachnoiditis" graduallyturns into atavism, since it is pathologically and clinically difficult to separate the inflammation of the arachnoid membrane. Doctors are inclined to believe that all manifestations of irritation of the membrane will be called meningitis.
History and etiology
For the first time the term "arachnoiditis" in his dissertationintroduced into medicine Tarasenkov in the middle of the nineteenth century. A more detailed description of this disease was provided by the neuropathologist Bönninghaus. But he called it external serous meningitis.
Arachnoiditis, like inflammation of other membranes,occurs after acute and chronic infectious diseases, sinusitis, against the background of chronic intoxication with heavy metal salts and injuries. In addition, pathology may appear on the background of the oncological process and encephalitis.
The most common cause of arachnoiditis is chronic suppurative otitis media and its complications: labyrinthitis, petrosite, and sinus thrombosis. Therefore, it is localized in the posterior or middle cranial fossa.
The disease downstream is divided into acute,subacute or chronic. And according to the prevalence of the process, spilled and limited arachnoiditis is isolated. As a rule, they are combined or follow each other in the clinical picture.
Symptoms
How does a disease likearachnoiditis of the brain? Symptoms are a combination of cerebral and local disorders. The former are associated with an increase in the pressure of the cerebrospinal fluid, and the latter indicate the location of the inflammatory focus. Depending on which symptom complex prevails, the manifestations of the disease may vary.
Чаще всего в клинике встречаются жалобы на headache that is accompanied by nausea and vomiting, not bringing relief. The pain can be focused in one place, intensified during movement, mental or physical stress. In addition, there is dizziness (even when lying down), irritability, severe weakness, combined with sleep disturbances. Photophobia, intolerance to loud sounds, muscular rigidity may occur.
But this is not the only thingarachnoiditis of the brain. Signs of focal disorders depend on the location of the pathological process. If the lesion is located on the convex surface of the brain, then most likely the patient will experience loss of function, episodes of epileptic seizures. The location of inflamed tissue on the lower surface of the brain causes disorders of the cranial nerves. These are symptoms such as loss of vision or loss of its fields, neuritis of the facial, trigeminal nerve, decrease in smell. They can be combined with manifestations of affection of the autonomic nervous system (excessive sweating, blue skin, thirst, frequent urination, increased blood glucose).
In the system of education and circulation of cerebrospinal fluid toomay be arachnoiditis of the brain. Symptoms of this condition are manifested in a sharp increase in temperature, vomiting, pain in the neck and neck, nystagmus and an increase in tendon reflexes. In such cases, it is necessary to differentiate the pathological symptoms from the development of tumors of the posterior cranial fossa. But lumbar puncture can be performed only if there is no stagnation in the fundus.
Cerebral arachnoiditis
Если воспалительный очаг располагается на a convex (convexital) surface, it is called the cerebral arachnoiditis of the brain. Its symptoms include manifestations of lesions of the lining of the brain and impaired fluid outflow. The most common first symptom is severe headaches. Due to tissue edema, the normal circulation of CSF will be difficult, leading to its accumulation and the development of intracranial hypertension.
Cerebral arachnoiditis of the brain, symptomswhich can mimic under other pathologies, often located in the frontal lobe, in the area of the central gyrus. Because of this, motor disturbances in the form of amplification or loss of movement or sensitivity often occur. When irritation and compression of the cortex can be focal epileptiform seizures. In the case of a severe course, large convulsive seizures occur, which can become epileptic. In such cases, electroencephalography plays an important role. Modern doctors rarely use pneumography because of the specific technique of introducing air into the brain lining, although this method of research in this case is also very informative.
Optical chiasmatic arachnoiditis
In clinical practice in the area of crossoptic nerve is the most common brain arachnoiditis. Symptoms of this localization are specific enough for timely diagnosis. Of the reasons can be identified malaria, syphilis, traumatic brain injury and sore throat.
In the area of optic chiasm are formedadhesions and cysts with serous contents, and in especially neglected cases, dense scar tissue appears around the chiasm. This variant of the course of the disease is not strictly local. Changes in the nervous tissue can also be observed at a considerable distance from the focus. Due to inflammation, the optic nerves on both sides are compressed and, as a result, ischemia.
The disease develops slowly, first strikingone eye, and then, after a few weeks, and the other. Throughout the development of the disease, the patient complains of pain behind the eyeballs. This allows differential diagnosis with neuritis of various etiologies. To determine the location of inflammation using the definition of visual fields and examination of the fundus. The most specific is the loss of the temporal fields of view or concentric it narrowing. This suggests that the center of inflammation is located in the center, between the optic tracts.
Arachnoiditis of the posterior cranial fossa
In the posterior fossa most oftencerebral arachnoiditis of the brain is localized. Its symptoms resemble occipital lobe tumors and consist of cerebellar and stem manifestations (lesion of the fifth, seventh and eighth pairs of cranial nerves).
The defeat of the cerebellum is manifested in instabilitywalking and in a static position, lack of coordination of arm and leg movements, as well as the impossibility of simultaneously performing several actions, since the patient needs to visually control his limbs to do everything correctly.
Symptoms depend on the type of inflammation (cystor adhesions), its localization and combination with hydrocephalus. The latter may occur due to the overlap of the openings of the lateral ventricles of the brain as a result of pathological changes in tissues. The excess fluid irritates the meninges and causes an increase in intracranial pressure. Manifestations of this syndrome are a sharp headache, nausea, vomiting, dizziness, slowing of the heartbeat.
Spinal arachnoiditis
This type of lesion occurs when current is injected.CSV or blood circulation in the spinal cord will get the infectious agent that caused arachnoiditis of the brain. Symptoms and effects depend on the spread of the process and the number of damaged roots. The causes of the development of the disease in addition to those already mentioned may be boils and purulent abscesses.
Spinal cord lesion clinic is similar towith extramedullary tumor. The most frequent localization is the thoracic and lumbar segments, the horse's tail region. In the cerebrospinal fluid is observed cell-protein dissociation. As a rule, the spinal form of arachnoiditis is chronic.
Diagnostics
Getting the diagnosis, the doctor firstcollects a history of life and health, then conducts a physical examination, including describes the neurological status. And only after that attracts additional laboratory and instrumental methods of research.
В первую очередь задача невропатолога – исключить a brain tumor that can mimic arachnoiditis of the brain. Symptoms, photo of the skull on a computer or magnetic resonance therapy will help in this. In addition, signs of intracranial hypertension will be visible on the craniogram. Echoencephalography, angiography and scintigraphy are also considered informative, but the doctor is primarily focused on MRI.
Электроэнцефалография помогает локализовать очаги inflammation and find out the cause of epileptic seizures. Analysis of the CSF shows a moderate number of cells, a slight protein dissociation, but the cerebrospinal fluid flows under pressure, which confirms hydrocephalus. In addition, after this procedure, the patient's well-being is improved by reducing intracranial pressure.
Treatment
How to treat arachnoiditis of the brain?This task is quite time-consuming. First you need to find out the cause of the inflammatory reaction and try to eliminate it. For this purpose, broad-spectrum antibiotics are used that fall through the blood-brain barrier. To reduce tissue edema, antihistamines and desensitizing drugs are used.
Лечение арахноидита головного мозга рассчитано на long term therapy by means that absorb scar tissue. In addition, it is necessary to normalize intracranial pressure, improve the outflow of cerebrospinal fluid, stimulate cerebral circulation and oxygen delivery to the nervous tissue.
In general, it is necessary to restore everything that I managed.damage arachnoiditis of the brain. Treatment with medicines, such as biogenic stimulants, Lidazoy, Pyrogenal, with courses of fifteen injections every six months, gives positive results even in difficult cases of the disease. To reduce the pressure using diuretics and decongestants. Antiepileptic drugs are excellent for relieving convulsive syndrome.
As a prophylaxis, general strengthening therapy is carried out; if there are additional problems, symptomatic treatment is performed.
Prognosis and prevention
Своевременное лечение арахноидита головного the brain usually ends in recovery. The danger can only be an inflammatory process, which is located in the posterior cranial fossa and is accompanied by the overlapping of the ventricular openings of the brain. The prognosis is worsened by the frequent relapses of the disease or its progressive course against the background of hypertensive crises, epileptiform seizures, and the localization of inflammation in the projection of the optic chiasm.
What should be done to preventarachnoiditis of the brain? Its consequences are serious enough, so you should pay attention to your health and in time to go to a medical institution for help. It is necessary to carry out the prevention of sinusitis, otitis and frontitis, to take root on the calendar, and most importantly, to treat all infectious diseases in time and to the end. Because they lead to the development of arachnoiditis.
Working capacity
Brain arachnoiditis can cause disability in a person. Even against the background of relative clinical well-being, the consequences of the infection were lifelong.
Третья группа инвалидности присваивается больным, who are able to serve themselves, as well as perform light work. They are encouraged to change their profession and lead a correct lifestyle as far as possible.
The disability of the second group the patient receives ifafter treatment, he still had episodes of epileptic seizures and decreased visual acuity. They can no longer fulfill their professional duties, but they are fully capable of serving themselves. Patients of the first group are considered to be patients who, as a result of the disease, have completely lost their sight.
Patients with the third group is contraindicated.work at height, at an open flame and moving mechanisms, in transport. It is recommended to eliminate difficult meteorological conditions associated with changes in atmospheric pressure, work in noisy gas-filled rooms, and work associated with vibration.
After the doctor has diagnosed arachnoiditisbrain, "the symptoms, treatment and rehabilitation of patients are carefully studied by the specialists of the medical-social expert commission. Any, even the smallest detail, can affect the decision on granting the status of a disabled person, as this is followed by certain benefits.
