PROGNOSIS

Arachnoiditis has been described as an insidious disease that is incurable. Guyer’s paper on the prognosis of arachnoiditis ([38]) suggests that there tends to be a spectrum of the course of the disease, which varies from mild and non-progressive, to a fulminating progression that may cause paralysis and even death. Wilkinson ([39]) believes that progression after the first 24 months is unlikely to be due to the disease process alone. Most authors state that its onset may be years after the precipitating cause.

In general, arachnoiditis presents a highly variable clinical picture, with a fluctuating course. Some patients seem to reach a “plateau” and stabilise without further deterioration, whereas there is a group of patients who develop a relatively rapid progressive deterioration (within a matter of months) during which they tend to lose function in the affected limb(s). This tends to happen after a seemingly trivial event such as a minor fall or car accident.

Table of Contents

Introduction
THE SCALE OF THE PROBLEM
ARACHNOIDITIS OR EPIDURAL FIBROSIS?
NOMENCLATURE
THE INFLAMMATORY NATURE OF ADHESIVE ARACHNOIDITIS
PATHOLOGY
CLASSIFICATION
CAUSES
THE IATROGENIC ASPECT OF ADHESIVE ARACHNOIDITIS
PRESERVATIVES IN SPINAL INJECTIONS
PROGNOSIS
NEXT: THE SYNDROMIC NATURE OF SYMPTOMS IN ADHESIVE ARACHNOIDITIS (Warning: LONG)
COMPLICATIONS OF ADHESIVE ARACHNOIDITIS
DIFFERENTIAL DIAGNOSIS
CLINICAL ASSESSMENT
DIAGNOSTIC TESTS
TREATMENT OPTIONS (Warning: LONG)
MULTIPLE CHEMICAL SENSITIVITY
LOOKING TO THE FUTURE
APPENDIX I: AUTOIMMUNE ASPECTS
APPENDIX II: SYRINGOMYELIA
ADDENDUM - May 2000
REFERENCES