Aracnoiditis/Arachnoiditis

Aparición tardía de aracnoiditis espinal tras un bloqueo caudal


Delayed occurrence of spinal arachnoiditis following a caudal block.
Na EH, Han SJ, Kim MH.
School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
J Spinal Cord Med. 2011 Nov;34(6):616-9. doi:10.1179/2045772311Y.0000000035.
Abstract
CONTEXT: Spinal arachnoiditis is a rare disease caused by fibrosis and adhesion of the arachnoid membrane due to chronic inflammation. The causes of arachnoiditis are infection, spinal surgery, intraspinal injection of steroid or myelography dye, and spinal anesthesia. METHOD: Case report.FINDINGS: A 60-year-old woman presented with progressive weakness and sensory change of both legs and urinary symptoms. She had received a single caudal block 6 months before symptom onset. Magnetic resonance imaging of the thoraco-lumbar spine showed an intradural extramedullary tumor at the T5-T7 level. She underwent laminectomy and tumor resection. The pathological finding was arachnoiditis. After surgery, a rehabilitation program of strengthening exercises of both lower extremities and gait training was started. At 2-month follow-up, she was able to walk with orthoses and performed daily activities with minimal assistance. CONCLUSION: Symptoms of spinal arachnoiditis occurred 6 months after a single caudal block in this woman. Clinicians should be aware of this possible delayed complication.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237290/pdf/scm-34-616.pdf




Bloqueo epidural obstétrico y aracnoiditis crónica adhesiva

Obstetric epidurals and chronic adhesive arachnoiditis.
Rice I, Wee MYK, Thomson K.
Br J Anaesth 2004; 92: 109-20
It has been suggested that obstetric epidurals lead to chronic adhesive arachnoiditis (CAA). CAA is a nebulous disease entity with much confusion over its symptomatology. This review outlines the pathological, clinical, and radiological features of the disease. The proposed diagnostic criteria for CAA are: back pain that increases on exertion, with or without leg pain; neurological abnormality on examination; and characteristic MRI findings. Using these criteria, there is evidence to show that epidural or subarachnoid placement of some contrast media, preservatives and possibly vasoconstrictors, may lead to CAA. No evidence was found that the preservative-free, low concentration bupivacaine with opioid mixtures or plain bupivacaine currently used in labour lead to CAA.
http://bja.oxfordjournals.org/content/92/1/109.full.pdf



Aracnoiditis crónica adhesiva
Chronic adhesive arachnoiditis
J. A. Aldrete
Birmingham, AL, USA
British Journal of Anaesthesia 93 (2): 301-7 (2004)
Editor-The review on the topic of 'chronic adhesive arachnoiditis' (CAA) from obstetric epidurals by Rice and colleagues1 was apparently triggered by a series of articles that appeared in one of the London tabloids, fostered by some of the members of the Arachnoiditis Trust. These articles were unreasonable to many of us that remember the statistics of maternal deaths in the 1970s in the UK,2 when general anaesthesia was the predominant form of analgesia; aspiration of gastric contents and difficulty with tracheal intubation were the main culprits. I also feel that it is the right of women in labour to ask for pain relief, and anaesthetists ought to provide it for them. But we cannot deny that neuroaxial anaesthesia produces morbidity and that neurological deficits are probably one of the most serious. Unfortunately, the authors of the review lost the opportunity to assess the subject of neurological deficit and arachnoiditis (ARC) after epidural anaesthesia. Instead of being impartial, they attempted to prove that adhesive arachnoiditis does not happen as frequently as the patrons of the 'Trust' claimed it did and, when it does occur, they dismissed it as irrelevant.
http://bja.oxfordjournals.org/content/93/2/301.full.pdf+html




Aracnoiditis. Sumario breve de la literatura

Arachnoiditis. A brief summary of the literature
Peter Day
This report is a brief descriptive summary review on arachnoiditis in the form of a background paper. A comprehensive and evidence-based systematic review of the literature is not presented here. This review is a synthesis of information available in the literature that addresses the following: a summary of available literature, the nature and etiology of arachnoiditis, the characteristics of diagnosis, estimates of the prevalence and incidence of arachnoiditis, prognosis, treatment and future outlook for the condition, prevention, and arachnoiditis as a public health concern in New Zealand. The report was commissioned by the Ministry of Health.
http://www.otago.ac.nz/christchurch/otago014038.pdf





Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org