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do i have arachnoiditis.

The majority of AA cases arise iatrogenically, that is, ARE CAUSED BY MEDICAL INTERVENTION.
It is helpful to divide the causes into 3 main groups:


Ø Myelogram: oil-based (Pantopaque/Myodil) and water-based: Metrizamide, Dimer-X, Omnipaque, Amipaque. Procedure used as a diagnostic tool before availability of MRI scans, still in use occasionally. Oil-based dyes remain in the central nervous system as either a thin film or as encapsulated deposits, commonly in the lumbosacral region or in the base of the skull (basal cisterns).

Ø Epidural /intrathecal steroid injection: therapeutic measure commonly used in both acute and chronic back pain cases, including prolapsed discs. Benefit is questionable and temporary (up to 2-3 months). Risk of arachnoiditis is controversial; evidence of toxicity of the preservatives in the preparation points to a need to reappraise the continued clinical use of this procedure. Preservative-free solutions (Celeston Soluspan/Decadron) may confer lower risk, but this invasive treatment remains one in which risk may well outweigh benefit.

Ø Chymopapain: this agent has been used as a chemonucleolytic agent; it is an enzyme, which breaks down disc material that has leaked due to a disc herniation (prolapse).

Ø Chemical meningitis: may result from any of the above procedures; it involves acute inflammation of the meninges, often in both the spinal and cerebral (around the brain) areas.

Mechanically-induced AA (MIAA):
Ø Spinal surgery: especially multiple surgeries.

Ø Trauma

Ø Multiple lumbar punctures

Ø Spinal stenosis (when chronic)

Ø Anatomical abnormalities: especially degenerative conditions: e.g osteophytes (bony protuberances)

Ø Chronic disc prolapse: including leaked disc material, which is known to be highly irritant to nerves.

Ø Blood: bleeding into the spinal fluid due to invasive procedures or trauma (as above). Blood is extremely irritant to nerves. Subarachnoid haemorrhage may occur spontaneously (no invasive procedure precedes it) and can cause arachnoiditis.

Commonly, patients with AA will have undergone a variety of medical procedures, the condition being multifactorial in origin. This gives rise to problems with regard to attempted litigation. Further investigation comparing CIAA and MIAA needs to be undertaken in order to discern a workable clinical picture, which may be useful both in diagnostic terms and within a legal framework.


AA does not have a typical clinical presentation, although there are a number of features, which are common in people with the condition. However, the picture is somewhat complicated by the fact that the symptoms of AA occur against a backdrop of the original spinal problem for which invasive procedures were undertaken (except in a small minority in which no spinal condition has occurred, for instance, in AA secondary to epidural anaesthesia in childbirth).
It is important also to remember that a number of the symptoms experienced are common to various chronic illnesses and may well arise secondary to the general debility occasioned by unrelieved pain and stress resulting from dealing with illness that is relentless for years on end.

Chronic pain is not regarded by most of the medical profession as detrimental of itself; however, recently some doctors are beginning to voice a different point of view, recognising that unrelieved pain constitutes a source of constant stress on the body, resulting in over-production of stress response chemicals in the body, such as adrenaline, insulin and cortisol. These substances cause a variety of problems. In America, highly sophisticated PET scans have shown that chronic pain in some way alters the way in which the brain responds to stress or pain; the concentration of neurotransmitters (chemical nerve messengers) in certain brain areas seems to vary from that of healthy people.

In 1999, a global postal survey of people with arachnoiditis showed the following results:

1. Pain (100%)
2. Numbness/tingling (86%)
3. Sleep disturbance (84%)
4. Weakness (82%)
5. Muscle cramps/twitches/spasms (81%)
6. Stiffness (79%)
7. Fatigue (76%)
8. Joint pains (72%)
9. Balance difficulties (70%)
10. Loss of mobility (68%)

Other common symptoms seen in the typical case:

1. Bladder/bowel/sexual dysfunction(68%)
2. Increased sweating (63%);
3. Difficulty thinking clearly/Depression (63% /62%);
4. Heat intolerance(58%);
5. Dry eyes/mouth(58%) and
6. Weight gain (50%).

Other less common problems experienced include: Tinnitus (ringing in the ears), dental problems (tooth decay may be worsened by dry mouth due to loss of the protective power of saliva), abnormalities in the menstrual cycle, eyesight problems (difficulty in focussing may be due to medication).

The pain tends to be intractable and resistant to treatment, being predominantly neurogenic in origin. This causes persistent burning pain and intermittent stabbing or electric shock type pains. Burning in the feet is common and may be accompanied by a sensation of walking on broken glass.

There may also be a component of central pain, which is well known to be difficult to treat. This involves various bizarre sensations, such as pain felt on light touch or a change in temperature (allodynia) or pain felt in a different part of the body to the one being touched. People also experience sensations such as water running down the leg, or insect bites.

One doctor has likened the pain of AA to that experienced in cancer, but without the relief of death. Indeed, some sufferers become suicidal due to the unrelenting pain and the neurological deficits they experience.

AA is incurable and may be progressive in some cases. Usually people tend to ‘plateau out’ at a certain level of pain/loss of function, but in a minority, a relatively trivial event such as a slight fall or car accident, can set off a rapid decline.

Note: in the survey, a number of respondents had a diagnosis of an autoimmune disorder such as Lupus, Sjogren’s, Rheumatoid arthritis. There appears to be a possible link between AA and autoimmune type problems. Out of 317 survey respondents, 27 had thyroid disorders, all except one having previously undergone myelography. As myelogram dyes contain iodine, there may be a significant link between the myelogram and subsequent thyroid disease; this is currently being investigated. There are also a number of arachnoiditis patients who have also been diagnosed with Multiple Sclerosis, as well as several more who have undergone investigation for MS. Those who have a diagnosis of fibromyalgia in addition to arachnoiditis are probably suffering from the condition as a secondary feature of the underlying arachnoiditis; fibromyalgic type symptoms of diffuse muscle tenderness and fatigue are common in arachnoiditis patients.

Many people who have symptoms such as those described and a history of risk factors for AA still have difficulty in getting a diagnosis. As the condition is perceived to be rare, doctors often do not consider it a likely diagnosis. It is important that treatable conditions such as recurrent disc herniation are identified and treated and this can be achieved through the use of an MRI scan. High resolution scans may also be able to demonstrate AA, although in the early stages it might not be picked up. In any case, one must bear in mind that MRI scan results often fail to correspond accurately to the clinical picture. Heavy reliance on the need for a diagnosis is unadvisable, and often unnecessary, as management of symptoms is the only option, AA being incurable.
EMG (electromyogram) or NCV (nerve conduction velocity) tests may be performed to assess nerve damage. If there is loss of bladder control, urodynamic studies may be undertaken to fully assess the problem.

DIFFERENTIAL DIAGNOSIS:

This refers to other similar diagnoses which may be relevant:
Ø Failed Back Surgery Syndrome: in fact, arachnoiditis probably accounts for over 10% of FBSS cases; FBSS is common, incidence varying from 25% to 40% of all spinal surgery cases. The commonest causes include: epidural fibrosis, recurrent disc herniation, spinal stenosis (narrowing of the spinal canal or the foramina (holes in the vertebrae) through which the nerve roots exit from the spinal cord. It is important that treatable causes such as reherniation of a disc, are identified and treated.

Ø Multiple Sclerosis: as mentioned above, it is quite common for arachnoiditis patients to be investigated for MS.

Ø CRPS: previously termed RSD: reflex sympathetic dystrophy, CRPS Type I refers to problems in one limb, often after trauma/surgery: pain, swelling and changes in skin colour and temperature, abnormal sweating: increased/decreased (bone density lost in later stages). CRPS Type II (previously causalgia) refers to more widespread problems, other than in the area affected by an injured nerve and resembles arachnoiditis. Continuous pain, allodynia (pain from non-painful stimulus such as light touch/clothing/temperature change) and/or hyperalgesia (heightened pain) can occur. (also: skin rashes, abnormal body temperature, tremors (shakes), tripping/falling.)

Ø Cauda Equina Syndrome: acute CES is a surgical emergency; loss of bladder/bowel function, saddle anesthesia (loss of sensation or tingling in the buttocks and around the anus/vagina/genitals), leg weakness and severe pain in the lower back/limbs/genitals. CES is basically a descriptive term for a set of symptoms. It may arise when there is a severe compression in the cauda equina, (horse’s tail) at the lower end of the spinal cord (acute causes include large disc prolapse). A chronic equivalent to CES may arise in arachnoiditis.