Diagnosis
of arachnoiditis and Tarlov cysts
The aseptic Arachnoiditis is harder to diagnose than the Tarlov cysts. The latter have a clearly visible morphological display (the cysts) in the MRI picture. In the acute phase, the Arachnoiditis is visible with indirect signs in the early stages and rarely in the later stages using for example contrast agents in the Leptomeninges. The classification of the stages is performed using the ‘Hoffmann Stage I-IV’ scale. The disease not necessarily follows all the stages to the highest one. It often remains in one.
If the image (MRI) is questionable, if the symptoms can be caused by other, more common diseases, a thorough examination and a detailed research into the history of the various symptoms is needed to perform the diagnosis.
We have often observed that several years can pass by between the event that is the cause of the disease and the first sign of symptoms. This may be due to the very slow metabolic rate of the Leptomeninges.
So many questions remain unanswered as far the cause of origination is concerned. Worldwide many known causes of an aseptic Arachnoiditis in people is occurring in the field of medical procedures, such as lumbar punctures, epidural anesthesia during operations and cortisone shots in pain management. But only a very small number of patients (thousandth part) develop this rare disease. This points to the assumption that at least one additional factor should be present that leads to the disease in combination with the original event that caused it.
There is reason to presume that it may be an auto-immune aggressive process, which could either be a genetic predisposition or an adopted peculiarity of the immune system which permits this chronic inflammation process against the endogenic structure.
Research in this area is not very advanced. The goal of our efforts is to start systematic research in this topic.
