-
Anaesthesia Apr 2013
Topics: Anesthesia, Obstetrical; Anesthesia, Spinal; Arachnoiditis; Female; Humans; Paraplegia; Pregnancy
PubMed: 23488837
DOI: 10.1111/anae.12156 -
The British Journal of Radiology Aug 2011Cerebrospinal fluid (CSF) spaces include ventricles and cerebral and spinal subarachnoid spaces. CSF motion is a combined effect of CSF production rate and superimposed... (Review)
Review
Cerebrospinal fluid (CSF) spaces include ventricles and cerebral and spinal subarachnoid spaces. CSF motion is a combined effect of CSF production rate and superimposed cardiac pulsations. Knowledge of CSF dynamics has benefited considerably from the development of phase-contrast (PC) MRI. There are several disorders such as communicating and non-communicating hydrocephalus, Chiari malformation, syringomyelic cyst and arachnoid cyst that can change the CSF dynamics. The aims of this pictorial review are to outline the PC MRI technique, CSF physiology and cerebrospinal space anatomy, to describe a group of congenital and acquired disorders that can alter the CSF dynamics, and to assess the use of PC MRI in the assessment of various central nervous system abnormalities.
Topics: Adolescent; Adult; Aged; Arachnoid Cysts; Arnold-Chiari Malformation; Cerebrospinal Fluid; Child; Child, Preschool; Contrast Media; Female; Humans; Hydrocephalus; Magnetic Resonance Imaging; Male; Middle Aged; Subarachnoid Space; Syringomyelia; Young Adult
PubMed: 21586507
DOI: 10.1259/bjr/66206791 -
Fluids and Barriers of the CNS May 2019The blood brain barrier (BBB) is the main barrier that separates the blood from the brain. Because of the BBB, the drug concentration-time profile in the brain may be... (Review)
Review
The blood brain barrier (BBB) is the main barrier that separates the blood from the brain. Because of the BBB, the drug concentration-time profile in the brain may be substantially different from that in the blood. Within the brain, the drug is subject to distributional and elimination processes: diffusion, bulk flow of the brain extracellular fluid (ECF), extra-intracellular exchange, bulk flow of the cerebrospinal fluid (CSF), binding and metabolism. Drug effects are driven by the concentration of a drug at the site of its target and by drug-target interactions. Therefore, a quantitative understanding is needed of the distribution of a drug within the brain in order to predict its effect. Mathematical models can help in the understanding of drug distribution within the brain. The aim of this review is to provide a comprehensive overview of system-specific and drug-specific properties that affect the local distribution of drugs in the brain and of currently existing mathematical models that describe local drug distribution within the brain. Furthermore, we provide an overview on which processes have been addressed in these models and which have not. Altogether, we conclude that there is a need for a more comprehensive and integrated model that fills the current gaps in predicting the local drug distribution within the brain.
Topics: Animals; Arachnoid; Biological Transport; Blood-Brain Barrier; Brain; Extracellular Fluid; Humans; Models, Theoretical; Pharmaceutical Preparations; Tissue Distribution
PubMed: 31092261
DOI: 10.1186/s12987-019-0133-x -
Acta Neurologica Belgica Feb 2021Spinal adhesive arachnoiditis is a rare pathology involving pia mater of the spinal cord and nerve roots. It can potentially lead to disability-many patients end up... (Review)
Review
Spinal adhesive arachnoiditis is a rare pathology involving pia mater of the spinal cord and nerve roots. It can potentially lead to disability-many patients end up wheelchair-bound due to subsequent paraparesis. It is an infrequent but possible cause of lower extremities weakness in patients with a history of spinal surgery, epidural anaesthesia, myelography or spinal tumors. Three patients, one male and two females, admitted to our unit due to paraparesis presented at least one of the above mentioned risk factors. Each of them had a severe course of illness-progressive paresis of lower extremities. All above cases were diagnosed with spinal adhesive arachnoiditis confirmed with Magnetic Resonance Imaging (MRI) scan-the most sensitive and specific diagnostic tool. Despite conservative treatment and intensive rehabilitation none of the presented patients preserved the ability to mobilise independently. Considering spinal adhesive arachnoiditis in patients with paraparesis and history of typical risk factors should be included in clinical diagnostic procedure.
Topics: Adult; Arachnoiditis; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Muscle Weakness; Thoracic Vertebrae; Tissue Adhesions
PubMed: 32833147
DOI: 10.1007/s13760-020-01431-1 -
AJNR. American Journal of Neuroradiology Feb 2023Arachnoiditis ossificans is an uncommon end-stage appearance of chronic adhesive arachnoiditis. Imaging features of arachnoiditis ossificans are characteristic and...
Arachnoiditis ossificans is an uncommon end-stage appearance of chronic adhesive arachnoiditis. Imaging features of arachnoiditis ossificans are characteristic and should be diagnosed to avoid unnecessary intervention and guide prognosis and management. In this case series, we retrospectively analyzed CT and MR imaging of 41 patients to identify common patterns of intrathecal ossification and present the common etiologies. Thirty-two patients had a confirmed history of spinal instrumentation, 7 were discovered on imaging without prior surgical history, 1 had a history of ankylosing spondylitis, and 1 had trauma. The most frequent site of ossification was at the conus and cauda equina. Four patterns of ossification were identified, including central, nerve root encasing, weblike, and peripheral. Arachnoiditis ossificans is an important, likely under-recognized consideration in patients who present with back pain. Diagnosis can be made readily on CT; MR imaging diagnosis is also possible but may be challenging.
Topics: Humans; Retrospective Studies; Osteogenesis; Arachnoiditis; Tomography, X-Ray Computed; Magnetic Resonance Imaging
PubMed: 36635055
DOI: 10.3174/ajnr.A7764 -
Neurology India 2018
Review
Topics: Arachnoid; Arachnoid Cysts; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Middle Aged; Syringomyelia; Treatment Outcome
PubMed: 30504600
DOI: 10.4103/0028-3886.246271 -
Journal of Neurochemistry Apr 2022The purpose of this study was to elucidate the absolute abundance of transporters, enzymes, receptors, and tight junction and marker proteins at human blood-arachnoid...
The purpose of this study was to elucidate the absolute abundance of transporters, enzymes, receptors, and tight junction and marker proteins at human blood-arachnoid barrier (BAB) and compare with those of dogs and pigs. Protein expression levels in plasma membrane fractions of brain leptomeninges were determined by quantitative targeted absolute proteomics. To realistically compare the absolute abundance of target molecules at the BAB among humans, dogs, and pigs, the unit was converted from fmol/μg-protein to pmol/cm -leptomeninges. Of a total of 70 proteins, 52 were detected. OAT1, OAT3, GLUT1, 4F2hc, EAAT1, EAAT2, MCT8, SMVT, CTL2, GFAP, Claudin-5, Na /K -ATPase, COMT, GSTP1, and CES1 were abundantly expressed at the human BAB (>1 pmol/cm ). The protein expression levels were within a 3-fold difference for 16 out of 33 proteins between humans and dogs and for 13 out of 28 proteins between humans and pigs. Both human-dog and human-pig differences in protein expression levels were within 3-fold for OAT1, OAT3, 4F2hc, xCT, OCT2, MDR1, BCRP, PEPT2, SYP, and MCT1. In contrast, OCT3, MCT4, and OATP1A2 were detected in humans but not in dogs or pigs. MRP3 was detected in dogs and pigs but not in humans. The absolute level of GLUT1 in humans was nearly the same as that in dogs but was 6.14-fold greater in pigs. No significant differences in the levels were observed between male and female dogs for nearly all molecules. These results should be helpful in understanding the physiological roles of BAB and cerebrospinal fluid pharmacokinetics in humans and their differences from dogs and pigs.
Topics: ATP Binding Cassette Transporter, Subfamily G, Member 2; Animals; Arachnoid; Biomarkers; Blood-Brain Barrier; Dogs; Female; Glucose Transporter Type 1; Humans; Male; Membrane Transport Proteins; Neoplasm Proteins; Swine; Tight Junctions
PubMed: 35226354
DOI: 10.1111/jnc.15599 -
BMJ Case Reports Feb 2022A 67-year-old man presented with a low-grade fever for 2 months, weakness of all four limbs for five days and altered sensorium for two days. He was recently diagnosed...
A 67-year-old man presented with a low-grade fever for 2 months, weakness of all four limbs for five days and altered sensorium for two days. He was recently diagnosed with AIDS and was treatment-naive. Investigations revealed a CD4 count of 27cells/mm MRI brain and spine exhibited bilateral cerebellar lesions with diffusion restriction, and severe arachnoiditis at the level of the lumbar spine. High suspicion of central nervous system tuberculosis in an endemic country like ours, led us to start antitubercular therapy and steroids. Repeated lumbar punctures resulted in a dry tap leading to a delay in diagnosis. Serum cryptococcal antigen detection came positive, following which antifungal treatment was initiated. Later a small amount of cerebrospinal fluid sample was obtained which confirmed the diagnosis of cryptococcosis. However, the patient worsened and succumbed to the illness. This case highlighted the rare presentation of cryptococcal cerebellar stroke and spinal arachnoiditis.
Topics: Aged; Antifungal Agents; Arachnoiditis; Cryptococcosis; Cryptococcus; Humans; Male; Stroke
PubMed: 35131790
DOI: 10.1136/bcr-2021-246824 -
Korean Journal of Radiology Feb 2021To determine whether changes in the transiting nerve rootlet or its surroundings, as seen on MRI performed after lumbar hemilaminectomy, are associated with persistent...
OBJECTIVE
To determine whether changes in the transiting nerve rootlet or its surroundings, as seen on MRI performed after lumbar hemilaminectomy, are associated with persistent postoperative pain (PPP), commonly known as the failed back surgery syndrome.
MATERIALS AND METHODS
Seventy-three patients (mean age, 61 years; 43 males and 30 females) who underwent single-level partial hemilaminectomy of the lumbar spine without postoperative complications or other level spinal abnormalities between January 2010 and December 2018 were enrolled. Two musculoskeletal radiologists evaluated transiting nerve rootlet abnormalities (thickening, signal alteration, distinction, and displacement), epidural fibrosis, and intrathecal arachnoiditis on MRI obtained one year after the operations. A spine surgeon blinded to the radiologic findings evaluated each patient for PPP. Univariable and multivariable analyses were used to evaluate the association between the MRI findings and PPP.
RESULTS
The presence of transiting nerve rootlet thickening, signal alteration, and ill-distinction was significantly different between the patients with PPP and those without, for both readers ( ≤ 0.020). Conversely, the presence of transiting nerve rootlet displacement, epidural fibrosis, and intrathecal arachnoiditis was not significantly different between the two groups ( ≥ 0.128). Among the above radiologic findings, transiting nerve rootlet thickening and signal alteration were the most significant findings in the multivariable analyses ( ≤ 0.009).
CONCLUSION
On MRI, PPP was associated with transiting nerve rootlet abnormalities, including thickening, signal alterations, and ill-distinction, but was not associated with epidural fibrosis or intrathecal arachnoiditis. The most relevant findings were the nerve rootlet thickening and signal alteration.
Topics: Adult; Aged; Aged, 80 and over; Arachnoiditis; Female; Fibrosis; Humans; Laminectomy; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Odds Ratio; Pain, Postoperative; Spinal Nerve Roots
PubMed: 32901462
DOI: 10.3348/kjr.2020.0194 -
The American Journal of Tropical... Jan 2020
Topics: Humans; Magnetic Resonance Imaging; Neurocysticercosis; Subarachnoid Space
PubMed: 31674300
DOI: 10.4269/ajtmh.19-0754