Arakhnoidit — the autoimmune inflammatory defeat of a web cover of a brain leading to formation in it of solderings and cysts. Clinically arakhnoidit it is shown likvorno-gipertenzionny, asthenic or neurotic by syndromes, and also the focal symptomatology (damage of craniocereberal nerves, pyramidal violations, cerebellar frustration) depending on primary localization of process. The diagnosis of an arakhnoidit is established on the basis of the anamnesis, assessment of the neurologic and mental status of the patient, data of Ekho-EG, EEG, lyumbalny puncture, ophthalmologic and otolaryngologic inspection, MPT and KT of a brain, KT-tsisternografiya. It is treated arakhnoidit generally complex medicamentous therapy including anti-inflammatory, dehydrational, antiallergic, anti-epileptic, rassasyvayushchy and neurotyre-tread medicines.
Today in neurology distinguish true arakhnoidit, the having autoimmune genesis, and the residual states caused by fibrous changes of a web cover after the postponed craniocereberal trauma or a neuroinfection (neurosyphilis, a brucellosis, botulism, tuberculosis, etc.). In the first case arakhnoidit has diffusion character and differs in the progressing or intermitiruyushchy current, in the second — often has local character and is not followed by a current progrediyentnost. Among organic defeats of TsNS true arakhnoidit makes up to 5% of cases. Most often arakhnoidit it is observed among children and young people aged up to 40 years. Men get sick twice more often than women.
Causes of an arakhnoidit
Approximately at 55-60% of patients arakhnoidit it is connected with the postponed earlier infectious disease. Most often it is viral infections: flu, viral meningitis and encephalomeningitis, chicken pox, Cytomegaloviral infection, measles, etc. And also the chronic purulent centers in a skull: periodontitis, sinusitis, tonsillitis, otitis, mastoidit. In 30% arakhnoidit is a consequence of the postponed craniocereberal trauma, most often subarakhnoidalny hemorrhage or a bruise of a brain though the probability of emergence of an arakhnoidit does not depend on weight of the received injuries. In 10-15% of cases arakhnoidit has no precisely established etiology.
Chronic overfatigue, various intoxications is contributing to development of an arakhnoidit by factors (including alcoholism), hard physical work in adverse climatic conditions, frequent SARS, repeated injuries it is not dependent on their localization.
Pathogenesis of an arakhnoidit
The web cover settles down between firm and soft brain covers. It is not spliced with them, but densely adjoins to a soft brain cover in places where the last covers a convex surface of crinkles of a brain. Unlike a soft brain cover web does not come into brain crinkles and under it in this area the subweb spaces filled with tserebrospinalny liquid are formed. These spaces are reported among themselves and with a cavity of the IV ventricle. From subweb spaces through granulations of a web cover, and also on perinevralny and perivaskulyarny cracks there is an outflow of tserebrospinalny liquid from a skull cavity.
Under the influence of various etiofaktor in an organism the antibodies to own web cover causing its autoimmune inflammation begin to be developed — arakhnoidit. Arakhnoidit is followed by a thickening and turbidity of a web cover, education in it soyedinitelnotkanny solderings and cystous expansions. Arakhnoidit solderings by which formation it is characterized, lead to an obliteration of the specified ways of outflow of tserebrospinalny liquid with development of hydrocephaly and the likvorno-gipertenzionny crises causing emergence of all-brain symptomatology. Accompanying the focal symptomatology arakhnoidit it is connected with the irritating influence and involvement in adhesive process of the subject brain structures.
Classification of an arakhnoidit
In clinical practice arakhnoidit classify by localization. Allocate cerebral and spinal arakhnoidit. The first is in turn subdivided on konveksitalny, bazilyarny and arakhnoidit a back cranial pole though at the diffusion nature of process such division is not always possible. On features of pathogenesis and morphological changes arakhnoidit divide on slipchivy, slipchivo-cystous and cystous.
Symptoms of an arakhnoidit
The clinical picture of an arakhnoidit is developed later a considerable period from influence of the factor which caused it. This time is caused by the happening autoimmune processes and can differ depending on by what it was provoked arakhnoidit. So, after the postponed flu arakhnoidit it is shown 3-12 months later, and after a craniocereberal trauma on average in 1-2 years. In typical cases arakhnoidit it is characterized by the gradual hardly noticeable beginning with emergence and increase of the symptoms characteristic of an adynamy or a neurasthenia: increased fatigue, weakness, sleep disorders, irritability, the increased emotional lability. On this background emergence of epileptic attacks is possible. Over time the all-brain and local (focal) symptoms accompanying begin to be shown arakhnoidit.
All-brain symptoms of an arakhnoidit
The all-brain symptomatology is caused by violation of a likvorodinamika and is in most cases shown by a likvorno-gipertenzionny syndrome. In 80% of cases arakhnoidit having patients complain of rather intensive holding apart headache which is most expressed in the morning and amplifying at cough, a natuzhivaniye, physical efforts. Are connected with increase in intra cranial pressure also morbidity at the movement of eyeballs, feeling of pressure upon eyes, nausea, vomiting. Often arakhnoidit is followed by noise in ears, a hearing impairment and not system dizziness that demands an exception from the patient of diseases of an ear (cochlear neuritis, chronic average otitis, adhesive otitis, a labirintit). Emergence of excessive touch excitability (bad shipping of sharp sounds, noise, bright light), vegetative frustration and vegetative crises, typical for vegeto-vascular dystonia, is possible.
Often arakhnoidit is followed by periodically arising sharp aggravation of liquorodynamic violations that is clinically shown in the form of liquorodynamic crisis — a sudden attack of an intensive headache with nausea, dizziness and vomiting. Similar attacks can occur to 1-2 times a month (arakhnoidit with rare crises), 3-4 times a month (arakhnoidit with crises of average frequency) and over 4 times a month (arakhnoidit with frequent crises). Depending on expressiveness of symptoms liquorodynamic crises subdivide into lungs, average weight and heavy. Heavy liquorodynamic crisis can last up to 2 days, is followed by the general weakness and numerous vomiting.
Focal symptoms of an arakhnoidit
The focal symptomatology of an arakhnoidit can be various depending on its primary localization.
Konveksitalny arakhnoidit can be shown by easy and medium-weight violations of physical activity and sensitivity in one or both extremities from the opposite side. In 35% arakhnoidit this localization is followed by epileptic attacks. Usually polymorphism of epipristup takes place. Along with primary and again generalized psychomotor simple and difficult attacks are observed. After an attack emergence of temporary neurologic deficiency is possible.
Bazilyarny arakhnoidit can be widespread or mainly be localized in optiko-hiazmalny area, a lobby or an average cranial pole. Its clinic is caused generally by defeat I, III and IV pairs of craniocereberal nerves located on the basis of a brain. There can be signs of pyramidal insufficiency. Arakhnoidit a forward cranial pole proceeds with violations of memory and attention, decrease in intellectual working capacity more often. Optiko-hiazmalny arakhnoidit is characterized by the progressing decrease in visual acuity and narrowing of visual fields. The specified changes most often have bilateral character. Optiko-hiazmalny arakhnoidit can be followed by damage of the hypophysis located in this area and lead to emergence of an endocrine and exchange syndrome similar to displays of adenoma of a hypophysis.
Arakhnoidit a back cranial pole often has the heavy current similar to tumors of a brain of this localization. Arakhnoidit a mosto-cerebellar corner, as a rule, it begins to be shown by damage of an acoustical nerve. However perhaps began with neuralgia of a trigeminal nerve. Then there are symptoms of the central neuritis of a facial nerve. At an arakhnoidita of the big tank to the forefront there is an expressed likvorno-gipertenzionny syndrome with heavy liquorodynamic crises. Cerebellar frustration are characteristic: incoordination, and cerebellar ataxy. Arakhnoidit in the field of the big tank can be complicated by development of okklyuzionny hydrocephaly and formation of a siringomiyelitichesky cyst.
Diagnostics of an arakhnoidit
To establish true the neurologist arakhnoidit can only after comprehensive examination of the patient and comparison anamnestichesky yielded, results of neurologic survey and tool researches. When collecting the anamnesis pay attention to gradual development of symptoms of a disease and their progressing character, recently postponed infections or craniocereberal injuries. The research of the neurologic status allows to reveal violations from craniocereberal nerves, to define focal neurologic deficiency, psycho-emotional and mnestichesky frustration.
The skull X-ray analysis in diagnostics of an arakhnoidit is a low-informative research. It can reveal only signs is long the existing intra cranial hypertensia: manual vdavleniye, osteoporosis of a back of the Turkish saddle. About existence of hydrocephaly it is possible to judge by these Ekho-EG. By means of EEG at patients with a konveksitalny arakhnoidit reveal a focal irritation and epileptic activity.
Patients with suspicion on arakhnoidit without fail have to be examined by the ophthalmologist. At a half of the patients having arakhnoidit a back cranial pole, at an oftalmoskopiya developments of stagnation in the field of a disk of an optic nerve are noted. Optiko-hiazmalny arakhnoidit is characterized by the concentric or bitemporal narrowing of fields of vision revealed at perimetry, and also existence of the central scotomas.
Hearing disorder and noise in an ear are a reason for consultation of the otolaryngologist. The type and degree of relative deafness are established by means of a threshold audiometriya. The elektrokokhleografiya, a research of the acoustical caused potentials, an acoustic impedansometriya is made for determination of level of defeat of the acoustic analyzer.
KT and MRT of a brain allow to reveal morphological changes which accompany arakhnoidit (adhesive process, existence of cysts, atrophic changes), to define character and degree of hydrocephaly, to exclude volume processes (a hematoma, a tumor, brain abscess). Changes of a form of subweb spaces can be revealed during KT-tsisternografiya.
The Lyumbalny puncture allows to receive exact data on the size of intra cranial pressure. The likvor research at an active arakhnoidit usually reveals increase in protein up to 0,6 g/l and quantity of cages, and also the increased maintenance of neurotransmitters (for example. serotonin). It helps to differentiate arakhnoidit from other cerebral diseases.
Treatment of an arakhnoidit
Therapy of an arakhnoidit is usually carried out in a hospital. It depends on an etiology and degree of activity of a disease. The scheme of drug treatment of the patients having arakhnoidit, can include anti-inflammatory therapy by glyukokortikosteroidny medicines (methylprednisolonum, Prednisolonum), rassasyvayushchy means (to a gialuronidaz, quinine, pirogenat), antiepileptic medicines (carbamazepine, to levetiratseta, etc.), dehydrational medicines (depending on extent of increase in intra cranial pressure — a mannitol, acetazoleamide, furosemide), neuroprotectors and metabolites (piracetam, meldoniya, a ginkgo of a bilob, a hydrolyzate of a brain of a pig and so forth), antiallergic medicines (, , , ), psychotracks (antidepressants, tranquilizers, sedative). The obligatory moment in treatment of an arakhnoidit is sanitation of the available centers of a purulent infection (otitis, sinusitis, etc.).
Heavy optiko-haozmalny arakhnoidit or arakhnoidit a back cranial pole in case of the progressing decrease in sight or okklyuzionny hydrocephaly are the indication for performing surgical treatment. Operation can consist in restoration of passability of the main likvorny ways, removal of cysts or separation of the solderings leading to a sdavleniye of nearby brain structures. For the purpose of reduction of hydrocephaly at an arakhnoidita application of the shunting operations directed to creation of alternative ways of outflow of tserebrospinalny liquid is possible: kistoperitonealny, ventrikuloperitonealny or lyumboperitonealny shunting.