Inflammation of the arachnoid membrane of the brain. Cerebral, cystic, post-traumatic arachnoiditis

There are many diseases that can lead to disability or fatal outcome. One of them is cerebral arachnoiditis. With this disease, sick people need immediate and effective treatment. With timely treatment, the prognosis for life is favorable. How can cerebral arachnoiditis be diagnosed? How is he treated? Before answering these questions, it is worth understanding what arachnoiditis is and how it is classified.

What is arachnoiditis?

The human brain and spinal cord are covered with three arachnoid (arachnoid) and soft tissue. Inflammation of the arachnoid membrane is a disease called arachnoiditis. In 60% of cases, the disease is provoked by infectious and infectious-allergic diseases. In 30% of cases, arachnoiditis occurs due to a previous traumatic brain injury. In the remaining people diagnosed with the disease, the etiology cannot be determined.

The term "arachnoiditis" has not found application in practice. Experts explain this by saying that there is no isolated lesion of the arachnoid mater, because it lacks its own vascular system. Signs of arachnoiditis in modern medicine referred to as serous meningitis.

Classification of the disease

Depending on the location of the pathological process, several types of disease are distinguished. One of them is spinal arachnoiditis. In this disease, inflammation occurs in the meninges that surround the spinal cord. Another type is cerebral arachnoiditis. It affects only the lining of the brain. Cerebrospinal arachnoiditis is characterized by a combination of the two above-mentioned types of disease.

There is another classification. According to it there are the following types ailment, this is arachnoiditis:

• rear cranial fossa;
• bases of the brain (basal);
• convex surface of the cerebral hemispheres (convexital);
• in the area of ​​intersection optic nerves(optic-chiasmatic);

Depending on the morphological changes, the following are distinguished:

• sticky;
• adhesive-cystic;

Causes of cerebral arachnoiditis

This disease can occur as a complication of various infectious diseases, or develop due to inflammatory processes occurring in the middle ear and paranasal sinuses. Thus, to causal factors include rheumatism, influenza, chronic tonsillitis, otitis media, rhinosinusitis, measles, scarlet fever, etc.

The cause of the disease is sometimes traumatic brain injury. This is post-traumatic cerebral arachnoiditis. Some experts believe that the disease can occur after a birth injury and make itself felt in adulthood after injury or infection.

General cerebral symptoms

Cerebral arachnoiditis is characterized by certain clinical manifestations. First of all, the disease makes itself felt by general cerebral symptoms. Headache is common. It is strongest in the morning. In some people it is accompanied by nausea and vomiting.

Headache may worsen with tension, straining, or awkward movements. In addition to it, people with cerebral arachnoiditis report dizziness. In patients, memory deteriorates, irritability appears, fatigue quickly sets in, sleep is disturbed, and general weakness is observed.

Symptoms reflecting the localization of the pathological process

They are not the only ones associated with the disease “cerebral arachnoiditis”. Additional symptoms may also occur, which reflect the localization of the meningeal process:

1. With arachnoiditis of the posterior cranial fossa, ataxia is observed. This is a violation of the coordination of muscle movements in the absence of muscle weakness. Nystagmus also occurs. This term refers to spontaneous movements of the eyeballs.
2. The basal type of the disease is characterized by dysfunction of those nerves that are located at the base of the skull.
3. With convexital arachnoiditis, general and Jacksonian epileptic seizures can be observed.
4. The opticochiasmal type of disease is characterized by deterioration of vision. Sick people note a “mesh before the eyes.” In severe cases of the disease, blindness occurs. Sometimes hypothalamic disturbances occur (for example, increased urination, thirst).
5. With arachnoiditis of the cerebellopontine angle, people suffer from headaches localized in the occipital region and tinnitus. Patients experience paroxysmal dizziness.

Diagnosis of cerebral arachnoiditis

The diagnosis is made by specialists taking into account clinical manifestations disease and neurological examination results. It includes studies of visual acuity, visual fields and fundus. Craniography is also performed. This is without contrast. In case of cerebral arachnoiditis, survey craniograms may reveal indirect signs of intracranial hypertension.

An electroencephalogram of the brain is also performed. Main role A pneumoencephalogram plays a role in diagnosis. The study allows us to detect uneven filling of the subarachnoid space with air, expansion of the ventricles of the brain, and focal accumulations of air. To obtain additional information and exclude other diseases, sick people are prescribed:

• CT scan;
• angiography;
• Magnetic resonance imaging;
• scintigraphy;
• other diagnostic methods.

Elimination of the disease

The disease cerebral arachnoiditis must be treated over a long period of time, in courses. To eliminate the source of infection, doctors prescribe antibiotics to their patients. The following tools are also used:

• anti-inflammatory;
• absorbable;
• hyposensitizing;
• dehydration, etc.

When increasing intracranial pressure Diuretics (for example, Furosemide, Mannitol) and decongestants are needed. If patients experience seizures, doctors prescribe antiepileptic drugs. If necessary, use symptomatic medicines.

Surgery

The use of medications does not always help eliminate a disease such as cerebral arachnoiditis. Treatment in some cases is surgical. Indications for surgical intervention are:

• lack of improvement after drug therapy;
• increase in intracranial hypertension;
• increase in focal symptoms;
• the presence of opticochiasmal arachnoiditis, which is characterized by a steady deterioration of vision.

For example, a neurosurgical operation can be performed when an adhesive process develops with the formation of adhesions or a cystic process in a disease such as cerebral arachnoiditis of the brain. Treatment of this kind will allow you to get rid of obstacles that interfere with the normal circulation of cerebrospinal fluid.

Prognosis and ability to work in cerebral arachnoiditis

Usually, the patient’s life is not in danger if treatment is started in a timely manner. A good prognosis is given for the convexital form of the disease. It is worse with opticochiasmatic inflammation. Arachnoiditis of the posterior cranial fossa with occlusive hydrocephalus is especially dangerous. It is worth noting that the prognosis can significantly worsen existing diseases and injuries.

People due to an illness can be recognized as group III disabled if light work reduces the volume of their production activity. With severe deterioration of vision and frequent convulsive seizures, group II disability is established. People become disabled in group I due to vision loss caused by opticochiasmatic arachnoiditis.

Causes of disability

It was said above that cerebral arachnoiditis can lead to disability. Thus, the disease provokes a limitation of life activity, i.e. patients completely or partially lose the ability or ability to carry out the main components Everyday life. This happens for the following reasons:

1. Convulsive seizures. Sick people periodically lose control over their behavior. In this regard, life activity is limited and ability to work is impaired.
2. Deterioration visual functions. In people suffering from cerebral arachnoiditis, visual acuity decreases and the field of vision narrows. They cannot work with small parts or perform their professional duties that require eye strain. Some people constantly need help from people around them due to blindness.
3. with the disease cerebral arachnoiditis. Consequences - the manifestation of hypertensive syndrome with repeated occurrences is accompanied by dizziness and disorientation.
4. Neurasthenia and related autonomic dystonia. People's endurance to climatic factors decreases, the ability for long-term physical and mental stress. Patients react negatively to loud sounds and too bright light.

Disease prevention

Cerebral arachnoiditis can be avoided. So, in order not to encounter this disease, it is necessary to pay attention to its prevention. It consists of timely treatment of those ailments that can provoke arachnoiditis. For example, when the first signs of sinusitis or otitis appear, you should immediately consult a doctor. The specialist will prescribe effective therapy in a timely manner. Adequate treatment is also necessary for traumatic brain injury.

In conclusion, it is worth noting that cerebral arachnoiditis of the brain is a disease that is not so easy to diagnose. If there are suspicious symptoms, various tests are prescribed. Also carried out differential diagnosis, because many diseases have a similar clinical picture (for example, brain tumors, normal pressure hydrocephalus, neurosarcoidosis, multiple sclerosis, idiopathic epilepsy).

Arachnoiditis – inflammatory pathology arachnoid (arachnoid) membrane of the brain. The word "arachnoiditis" itself comes from the Greek language and literally means "web" and "species". The name was proposed in 1845 by A. T. Tarasenkov. Synonyms: chronic fibrosing leptomeningitis, limited adhesive meningopathy.

Arachnoiditis is a special type of serous meningitis. As it develops, the spaces that are intended for the outflow of cerebrospinal fluid begin to stick together, which leads to disruption of the circulation of cerebrospinal fluid. As a result, it begins to accumulate in the cranial cavity and compresses the brain. This situation leads to the development of hydrocephalus or increased intracranial pressure.

Symptoms of the disease

Headaches, especially in the morning.

Fainting, dizziness.

Insomnia.

Aggression, anxiety, fear, depression.

Signs of epilepsy.

Increased or decreased sensitivity of the skin - a person ceases to feel heat, cold, touch or, conversely, feels them quite acutely.

Increased sensitivity to change weather conditions, frequent sweating or trembling.

Reasons for development

The most common are arachnoiditis of infectious origin, provoked by ear inflammation, throat diseases, brucellosis, toxoplasmosis, tonsillitis, acute pneumonia, syphilis, influenza. Post-traumatic arachnoiditis also often occurs after injury to the spine or head. The cause of the development of the disease can be osteomyelitis, epilepsy, or tumor. Much less often, the disease is provoked by metabolic disorders or endocrine pathologies. Sometimes it happens that install the real reason development of the disease for a long time does not work.

In the presence of arachnoiditis, the arachnoid membrane of the brain begins to thicken, acquires a light gray color, and adhesions arise between the hard, soft and arachnoid membranes. The adhesions begin to form an arachnoid cyst, which fills with cerebrospinal fluid. Over time, such a cyst thickens and turns into a tumor, the latter increases in size and begins to put pressure on the brain.

Factors that increase the risk of developing inflammatory process in the arachnoid membrane of the brain:

harmful working conditions and hard physical labor;

chronic alcoholism;

traumatic brain injuries - even the presence of a closed injury is extremely dangerous, especially if this is not the first time this situation has arisen;

acute purulent diseases - otitis media, mastoiditis, tonsillitis, sinusitis;

acute infections – meningoencephalitis, meningitis.

Classification

The main feature of the classification is the localization of the pathological process, accordingly the following are distinguished:

spinal arachnoiditis;

cerebral arachnoiditis.

In case of damage to the lining of the brain:

basal;

convexital.

According to the nature of the disease:

chronic;

• subacute

According to the mechanism of occurrence:

primary;

secondary.

There are also adhesive, cystic and cystic-adhesive arachnoiditis, multifocal and single-focal, limited and diffuse.

Basilar - occurs in a quarter of cases and is distinguished by the fact that its focus is located in the middle and anterior cranial fossa. In this case, there are serious mental disorders - increased fatigue, forgetfulness, decreased concentration.

Optico-chiasmatic - post-traumatic arachnoiditis, begins with a decrease in visual acuity in both eyes at once, is usually accompanied by optic neuritis and can cause the development of multiple sclerosis.

Cerebral arachnoiditis

With the development of cerebral arachnoiditis, symptoms appear as general nature, and focal. General symptoms include: headache, dizziness, signs of epilepsy, vomiting and nausea. In this case, the headache at first is of a normal nature, and then increases; attacks of severe pain can provoke the development of dizziness and vomiting. Changes in the fundus of the eye are also possible. Focal symptoms: nervous disorders, fear, anxiety, changes in skin sensitivity.

In most cases, arachnoiditis of the brain begins in a subacute or acute form after suffering trauma, an infectious disease and other reasons listed above. The acute form can be cured completely, but quite often the disease becomes chronic - with periods of exacerbation of symptoms and remission. Severe cystic adhesive arachnoiditis provokes the development of a tumor, which complicates treatment and makes the prognosis unfavorable.

Adhesive cerebral arachnoiditis is quite difficult to diagnose. The main symptoms are dizziness, headache, vomiting, which may be present in various pathologies. To differentiate the pathology, a number of special diagnostic measures are required.

Convexital arachnoiditis - the focus is localized in the area central sulcus and is accompanied by attacks of epilepsy, diffuse changes in brain biocurrents, and severe headaches.

Arachnoiditis of the posterior cranial fossa is quite common and one of the most dangerous variants of cerebral arachnoiditis. With this type of pathology, the nerves of the skull are affected, the cerebrospinal fluid tracts stick together, and severe pain appears in the back of the head, which radiates to the neck and back. Quite often paralysis begins to develop facial nerve and trigeminal neuralgia.

Spinal arachnoiditis

There are three types: cystic, adhesive and cystic-adhesive. According to the nature of the disease, it can be scattered or single-focal, limited or diffuse.

Diffuse spinal arachnoiditis is characterized by progression of sensory impairment and motor disorders. The course of the disease is varied and can occur with damage spinal cord and its shells. Echoes of meningitis can manifest themselves as Brudzinski's or Kernig's signs.

Limited spinal adhesive arachnoiditis quite often has an asymptomatic course; the nature of the lesion resembles the manifestations of radiculitis: sciatica, intercostal neuralgia.

Cystic spinal cord is quite similar in its manifestations to a spinal cord tumor. A person experiences difficulty moving, severe back pain appears, and at first it is localized on one side, after which it spreads to the entire back. Liqueur adhesions create pressure on the spinal cord, which leads to the formation of spinal compression syndrome.

In children, this disease is quite rare, accounting for about 2-3% of all pathologies of the nervous system. The main causes are injuries to the spine, head, complications of sinusitis, otitis, influenza, pneumonia.

Diagnostics

To diagnose pathology, the following research methods are used:

fundus examination;

echoencephalography;

Craniography - x-ray examination of the skull bones;

lumbar puncture;

computed tomography, MRI;

spinal cord examination with contrast;

pneumoencephalography;

examination of the patient by an otolaryngologist to determine possible reasons the occurrence of arachnoiditis;

examination by a psychiatrist for symptoms that are present in the patient, but not noticeable at first glance.

Treatment

Treatment of arachnoiditis is carried out in the hospital department. It is extremely important to conduct a correct diagnosis and find the main cause of the disease. After this, conservative treatment is prescribed:

prednisolone for two weeks with daily norm 60mg;

antihistamines;

drugs to reduce intracranial pressure;

means for therapy mental disorders– tranquilizers, antidepressants;

painkillers – if you have severe headaches;

brain stimulants – “Cerebrolysin”;

in the presence of epilepsy attacks, treatment with antiepileptic drugs may be prescribed.

Drugs are selected individually depending on the location and type of arachnoiditis in the patient. Treatment of adhesive arachnoiditis is very successful with conservative techniques, for cystic forms, the best option is surgery. Surgery usually prescribed against the background of lack of effect from conservative therapy.

When providing timely adequate treatment the prognosis of the disease is favorable. Arachnoiditis of the posterior cranial fossa is most difficult to treat, especially in the presence of cerebral hydrocele. After the operation, such patients become disabled. Patients cannot drive public transport, be in very noisy rooms, or perform heavy physical work. Employment outside the production workshops and without prolonged exposure to heights and the street is allowed.

Prevention

General measures for the prevention of viral diseases and a healthy lifestyle.

Timely treatment of already existing pathologies of a traumatic or infectious nature.

Complete diagnosis of arachnoiditis in case of closed head injury.

Regular examinations by an ophthalmologist and otolaryngologist. If you have mental problems, consult an appropriate specialist.

With successful treatment of the disease, relapse is prevented.

- This nervous system disease, in which inflammation occurs soft shell brain or spinal cord with predominant damage to the arachnoid ( arachnoid) shells. Isolated lesion of the arachnoid membrane ( true arachnoiditis) cannot be, since it lacks its own circulatory network. The long course of this pathology in the absence of treatment can lead to the formation of adhesions ( adhesions, septa) and cysts ( cavity with contents). Arachnoiditis most often occurs in children and adults ( more often in men) up to 40 years.

The following types of arachnoiditis are distinguished:

• cerebral arachnoiditis– is an inflammation of the soft membrane surrounding the brain;
• spinal arachnoiditis– is an inflammation of the soft membrane surrounding the spinal cord.

The following types of cerebral arachnoiditis are distinguished:(depending on location):

• convexital arachnoiditis– is an inflammation of the arachnoid membrane in the cerebral hemispheres, which is accompanied by a violation of neurological symptoms ( seizures, sensory disturbances);
• basal arachnoiditis– is an inflammation of the arachnoid membrane at the base of the brain and is manifested by damage to the cranial nerves, visual impairment and some metabolic processes;
• optochiasmatic arachnoiditis– is a type of basal arachnoiditis and is accompanied by various visual impairments ( decreased visual acuity and narrowing of visual fields) and color perception ( especially the perception of red and green colors);
• Arachnoiditis of the cerebellopontine angle– is a type of basal arachnoiditis and is accompanied by headache ( in the occipital region), dizziness, tinnitus, vomiting, as well as damage to the facial nerve;
• arachnoiditis of the posterior cranial fossa– accompanied by damage to the cranial nerves, impaired coordination of movements ( staggering when walking), headaches, impaired circulation of cerebrospinal fluid.

The following types of arachnoiditis are distinguished:(according to the mechanism of occurrence):

• adhesive arachnoiditis– is an inflammation of the arachnoid membrane of the brain, in which adhesions are formed ( fusions), leading to disruption of the circulation of cerebrospinal fluid and the appearance of severe headaches;
• cystic arachnoiditis- is an inflammation of the arachnoid membrane of the brain, in which cavities are formed ( cysts);
• adhesive cystic arachnoiditis– develops as a result of inflammation of the membranes of the brain and their adhesion, with cysts forming between the areas of adhesion.

The meninges are special membranes that cover the brain ( main organ of the central nervous system). These structures are located in the cranial cavity and separate the brain from the inner surface of the skull. There are outer, middle and inner membranes of the brain. These membranes also surround the spinal cord.

Outer shell

Outer meninges ( hard) is a dense whitish formation. It consists of an outer and inner surface. The outer surface fits tightly to the bones of the skull. The inner surface is smooth, shiny and faces the middle shell. The inner surface forms several processes that pass into the deep crevices of the brain. The thickness of the outer shell varies and depends on what part of the brain it covers. Dura shell, covering top part brain, has 0.7 - 1 mm. The hard shell covering the lower part of the brain is 0.1 - 0.5 mm. In some places it has splits ( bifurcation), which are called sines ( venous sinuses). Venous blood flows in these formations.

Middle shell

Middle meninges ( arachnoid, arachnoid) is one of three membranes that covers the brain and spinal cord and is a thin ( in the form of a web), transparent education. It is located between the other two meninges– dura mater and pia mater. Many branching fibers in the form of threads extend from the arachnoid membrane ( trabeculae). These structures are woven into the pia mater, which is located under the arachnoid membrane. The middle meninges are covered on both sides nerve cells (glial cells). The space located between the outer and middle membranes is called the subdural space. It contains a special liquid ( cerebrospinal fluid). This liquid is a nutrient medium for the brain. Unlike the dura mater, the arachnoid membrane does not penetrate into the fissures of the brain. It does not contain blood vessels.

Inner shell

Inner shell ( vascular, soft) is a structure that is located between the arachnoid membrane and the surface of the brain. It penetrates into all its cracks and furrows. The inner lining contains a large number of blood vessels that supply blood to the brain. The space located between the arachnoid and choroid is called subarachnoid ( subarachnoid) space. It contains approximately 120–140 ml of cerebrospinal fluid. In some places, this space forms significant expansions, which are called tanks.

The following functions of the meninges are distinguished:

• protective ( barrier) function– is the main function of the meninges, which protects the brain from mechanical damage;
• circulatory function– meninges promote blood circulation and nutrition of the brain;
• restrictive function– Separates parts of the brain from each other.

What happens in the arachnoid membrane of the brain during inflammation?

With inflammation of the arachnoid membrane of the brain, significant changes in its structure are observed. These changes occur under the influence of pathological microorganisms ( bacteria, viruses) And harmful substances, which they highlight ( toxins). The listed factors lead to damage to the structure of the middle meninx. In response to damage, special substances, so-called inflammatory mediators, begin to be released. Under their influence, the arachnoid membrane thickens and becomes much denser. It loses its transparency and becomes cloudy. Gradually, adhesions appear between the arachnoid, soft or hard membranes ( fusions). These formations interfere normal movement (circulation) cerebrospinal fluid. In addition, under the influence of the inflammatory process, cerebrospinal fluid is formed in large quantities (in excess). This liquid begins to stagnate. As a result of this process, bubbles are formed ( arachnoid cysts) of various sizes. At first they contain a clear liquid, which then becomes cloudy. These cysts become denser over time. They begin to put pressure on the brain and irritate its structures. These changes lead to significant consequences, which are manifested by impaired brain function.

Another mechanism for the formation of arachnoiditis is autoimmune influence. In this case, the body attacks its own cells, including the cells of the membranes of the brain. Under the influence of autoimmune processes, special structures are formed ( antibodies), the action of which is directed against the cells of the arachnoid membrane. As a result, swelling of the pia mater occurs. The channels through which cerebrospinal fluid flows are closed. This fluid accumulates and puts pressure on the structures of the brain. As a result of these pathological processes, a corresponding clinical picture of a disease such as arachnoiditis arises.

Causes of arachnoiditis

Various past infections can contribute to the development of arachnoiditis ( acute or chronic), inflammatory diseases of the ENT organs ( ear, throat, nose), injuries. In 10% of cases it is not possible to install exact reason development of arachnoiditis. Factors contributing to the development of this pathology include various poisonings ( intoxication with lead, arsenic, alcohol), constant overwork, hard physical labor in unfavorable conditions.

Causes of arachnoiditis

How is arachnoiditis treated for various pathologies?

Treatment of arachnoiditis can be medicinal or surgical and is usually carried out in a hospital ( in the hospital) in the Department of Neurology. The choice of treatment method depends on the cause of the disease and the degree of its activity ( manifestation of symptoms). Due to the fact that clinical symptoms of the disease begin to appear after a fairly long period of time after exposure to the provoking factor, treatment should be aimed at improving general condition and elimination of symptoms that bother the patient in this moment. Special attention attention must be paid to preventing the progression of the disease and preventing the development possible complications. In case of complicated arachnoiditis ( progressive vision loss, hydrocephalus) surgery may be indicated. For adhesive arachnoiditis, absorbable drugs are prescribed ( lidase, rumalon, pyrogenal). When convulsive attacks develop, they are treated with anticonvulsants ( phenobarbital). If the patient has an increase in intracranial pressure, diuretics may be prescribed that promote the excretion excess liquid from the body.

Treatment of arachnoiditis

Traditional methods of treating arachnoiditis can be used in combination with drug treatment for uncomplicated disease. Arachnoiditis is a disease of the nervous system that requires consultation with a specialist and selection of appropriate treatment tactics. Before starting treatment folk remedies it is necessary to consult a doctor, because in addition to useful properties There are also contraindications that can aggravate the patient’s general condition. In case of severe arachnoiditis and the presence of complications traditional methods treatments will be ineffective. If there is no effect from treatment with folk remedies or if any adverse reactions occur, it is also necessary to urgently consult a doctor to prescribe adequate treatment.

Lavender and honey

It is necessary to collect lavender flowers ( reddish color) and fill the jar with them. The filled jar with flowers is filled with honey and left to infuse for 6 months in a cool, dark place. It is necessary to stir the contents periodically. After six months, the resulting mixture is taken one tablespoon three times a day. Lavender relieves vasospasm, helps reduce headaches, and helps with cramps. Honey has an anti-inflammatory effect and helps improve immunity.

St. John's wort, sage and motherwort

For cooking this fee It is necessary to mix St. John's wort, sage and motherwort in equal proportions. After this, one tablespoon of the collection is poured with one liter of boiling water and left overnight ( in a thermos). In the morning you need to drink one glass of the resulting infusion. Drink the rest throughout the day. The course of treatment lasts one month. Then they take a break for several months and repeat the course. St. John's wort has anti-inflammatory and antispasmodic ( relieves spasm) action. Sage and motherwort have anti-inflammatory and antiseptic properties ( disinfecting) properties. Motherwort also helps remove excess fluid from the body, thereby reducing blood pressure.

Parsley root

You need to dry the parsley root and then grind it to a powder. One teaspoon of parsley powder is poured into a glass of boiling water and taken 3 times a day, 1/3 cup with meals. Parsley root has anti-inflammatory, disinfectant ( antiseptic), bactericidal ( ), analgesic, anticonvulsant, tonic effect.

Lemon, garlic and honey

To prepare this product, you need to mince a lemon ( 5 items) and garlic ( 5 medium heads). Then mix and add about 500 grams of honey. The resulting product is taken four teaspoons after meals three times a day. Lemon, garlic and honey are bactericidal ( destroys pathogenic bacteria) properties and strengthens immune system.

Fir oil

Fir oil can help with cerebral arachnoiditis. It is necessary to rub the oil into the temples, forehead, crown and around the ears. After application to the skin, a slight tingling sensation may be felt for several minutes. Fir oil has anti-inflammatory, bactericidal ( destroys pathogenic bacteria), analgesic properties, and also has a general strengthening effect, increasing protective forces body. The course of treatment lasts one month.

Aloe, elecampane, honey and wine

To prepare this decoction you will need aloe leaves ( 150 grams), elecampane root ( 50 grams), Bee Honey ( 500 grams) and red wine ( 2 liters). First, you need to prepare a paste from aloe leaves, which is then mixed with elecampane roots. After this, add bee honey and wine, mix and cook in a water bath for one hour. Before use, strain the decoction and take 1-2 tablespoons before meals ( 20 minutes before meals) 3 times a day. All ingredients have a healing effect and have an anti-inflammatory, strengthening effect.

Prevention of arachnoiditis is a complex medical task and consists in preventing the development of this pathology and possible complications. Since arachnoiditis can develop against the background of various diseases, intoxications and injuries, it is necessary to prevent their occurrence and promptly eliminate the provoking factor.

The following methods of preventing arachnoiditis are distinguished:

• maintaining a healthy lifestyle ( hardening, increasing immunity);
• regular visits to the doctor for medical examination;
• early diagnosis and timely treatment of infectious diseases;
• prevention of infectious diseases ( avoid contact with infected people, vaccinate children);
• timely treatment of inflammatory diseases of the ENT organs ( ear, throat, nose);
• increased caution when exercising dangerous species sports, being in a car to prevent traumatic brain injury;
• prevention of arachnoiditis with existing risk factors;
• timely prevention of relapse ( re-development of the disease).

Do people with cerebral arachnoiditis get accepted into the army?

The diagnosis of cerebral arachnoiditis established by a neurologist is a serious reason for declaring a person unfit for military service. As a rule, patients with such a diagnosis are assigned a disability group. The disability group is assigned depending on clinical symptoms and complications that may arise due to arachnoiditis. Such complications include the development of hydrocephalus ( excess fluid accumulation in the brain), the occurrence of frequent epileptic ( convulsive) attacks, decreased visual acuity up to the development of blindness. Military service requires physical and mental health. The above complications can only aggravate the course of cerebral arachnoiditis and lead to irreversible consequences.

Initially, cerebral arachnoiditis may manifest itself as increased fatigue, weakness, irritability, and sleep disturbances. Against the background of this condition, seizures may develop ( epileptic seizures). IN further illness progresses, and patients begin to experience constant headaches, eye pain, and tinnitus. Often cerebral arachnoiditis leads to disruption of the normal circulation of cerebrospinal fluid ( liquor), which may manifest as sudden onset of headache, dizziness, nausea and vomiting.

Depending on the location ( location) of cerebral arachnoiditis, clinical manifestations can be very diverse. With this disease, motor activity may be impaired ( coordination of movements) and sensation in one or both lower extremities. Impaired memory, attention, and decreased mental performance may also occur. Some forms of cerebral arachnoiditis lead to a progressive decrease in visual acuity and hearing loss. Such patients are prohibited from serving in the army, since any unfavorable conditions ( climate, physical or emotional stress) can provoke a deterioration in the patient’s general condition. Patients with cerebral arachnoiditis need to be regularly examined by a neurologist in order to stop the progression of the disease in time and prevent the development severe complications. As a rule, patients who have been diagnosed with arachnoiditis undergo a VTEC commission ( medical labor expert commission), which establishes the presence of the disease, the reasons for its development and the degree of disability. Accordingly, such patients cannot serve in the army.

What can be the consequences of cerebral arachnoiditis?

If left untreated, cerebral arachnoiditis may develop severe complications. The most severe cases of this pathology are considered to be paresis or paralysis, the development of hydrocephalus, epilepsy and blindness.

Paralysis is complete absence arbitrary ( independent) movements, loss motor functions. Paresis is an incomplete loss of motor functions and a decrease in muscle strength. These complications arise against the background of spinal arachnoiditis, when nerve structures are involved in the process. This may be due to injury to the spinal cord and its membranes in some diseases ( spondylosis, osteochondrosis), tumors, after repeated manipulations near the spine ( epidural block, lumbar puncture).

Hydrocephalus is an excessive accumulation of cerebrospinal fluid ( cerebrospinal fluid) in the brain. One of the reasons for the accumulation of fluid is a violation of its outflow due to the presence of adhesions ( adhesions) or cysts ( cavities), which can form with cerebral arachnoiditis. Another reason is excess secretion ( production) cerebrospinal fluid and impaired absorption ( absorption). With the development of hydrocephalus, intracranial pressure increases, and visual acuity gradually decreases. Hydrocephalus is also accompanied by constant headaches ( especially in the morning), nausea, vomiting ( bringing no relief). If this condition lasts for a long time and there is no necessary treatment pressure is exerted on brain structures, which can lead to death.

Epilepsy is a disease of the nervous system ( brain), which is characterized by the occurrence sudden attacks seizures ( epileptic seizures) and may be accompanied by loss of consciousness and foaming from the mouth. The development of this complication most often occurs with inflammation of the arachnoid membrane in the area of ​​the cerebral hemispheres, that is, with convexital arachnoiditis. The triggering mechanism for the occurrence of epilepsy attacks can be recent brain injuries. It is necessary to conduct a thorough diagnosis, since in some cases epileptic seizures may not be associated with the development of arachnoiditis.

Blindness is the complete loss of vision, the inability to see. This complication occurs, as a rule, with opticochiasmatic arachnoiditis, when the optic nerve is damaged. Initially, with opticochiasmatic arachnoiditis, there is a gradual decrease in vision, narrowing of the visual fields, eye fatigue, and impaired color perception ( It is especially difficult to distinguish between red and green colors). In the absence of timely and adequate treatment, visual impairment progresses and can lead to the development of complete blindness.

How does spinal arachnoiditis manifest?

With spinal arachnoiditis, inflammation of the arachnoid membrane of the spinal cord occurs. Clinical manifestations ( symptoms) diseases appear after a certain period of time ( in a few months or more) after exposure to a provoking factor on the body ( disease, intoxication, injury). This pathology is characterized by pain in the spine at the level of the pathological process ( thoracic, lumbar). At first, the pain is periodic, and then the patient feels it constantly. The first symptoms of spinal arachnoiditis are sensory disturbances in the limbs, weakening of tendon reflexes ( muscle contraction in response to stimulation). The patient may feel weakness and tingling in the legs, shooting pains. Sometimes the patient may feel numbness, muscle spasms ( spontaneous twitching) in the lower extremities. In some cases, dysfunction of the pelvic organs may occur.

In the acute period of the disease, spinal arachnoiditis, in addition to the above symptoms, may manifest itself high temperature, changes in the blood and cerebrospinal fluid characteristic of inflammation ( liquor).

Spinal arachnoiditis can be combined with cerebral arachnoiditis. In this case, the clinical manifestations will depend on the location ( localization) pathological focus and prevalence of the inflammatory process along the arachnoid membrane. Gradually developing symptoms of spinal arachnoiditis, if left untreated, disrupt the usual way of life and lead to disability. It is very important to be examined in time, identify all symptoms and begin treatment for early stage diseases.

How does arachnoiditis manifest in children?

Clinical manifestations ( symptoms) arachnoiditis in children depend on the location ( location) pathological process. For cerebral arachnoiditis ( cerebral arachnoiditis) is characterized by the appearance of pain in the back of the head, back of the neck and pain in the eyes. Also, with this pathology, children complain of rapid fatigue, a constant feeling of weakness and heaviness in the head. Against the background of elevated temperature, headache, nausea, vomiting, and dizziness appear. In severe cases, there is a progressive decrease in visual acuity ( up to complete blindness), convulsions, loss of consciousness. Spinal arachnoiditis is characterized by the development of pain at the level of injury, sensory disturbances and movement disorders.

Symptoms of arachnoiditis appear after a long period of time after exposure to the provoking factor and are complications of the underlying disease. This could be a few months later ( after infectious diseases) or even several years ( after suffering a traumatic brain injury). At the very beginning, the disease may manifest itself as fatigue, constant irritability ( psycho-emotional disorders) and memory impairment. The child's healthy sleep is disturbed and epilepsy attacks may occur ( seizures). With a significant severity of the process and a long course of the disease in children early age (from 1 year to 3 years) there may be a delay mental development.

In the subarachnoid space ( between the pia mater and the arachnoid mater) due to inflammatory changes, adhesions are formed ( fusions). In other cases, cysts may form ( cavities) of various sizes. All these changes disrupt the circulation of cerebrospinal fluid ( liquor) and lead to increased intracranial pressure ( intracranial hypertension ).

Is disability assigned to those suffering from arachnoiditis?

Depending on the clinical manifestations, patients suffering from arachnoiditis are assigned a certain disability group. This is due to the fact that this pathology may cause impairment. Disability is assigned to patients who experience frequent relapses ( return of the disease after apparent recovery), epileptic seizures ( convulsions), vision deterioration progresses.

The following disability criteria are distinguished:

• 3 disability group– assigned to patients whose volume of production activity decreases when transferred to a higher light work. Such patients need changes in working conditions due to the occurrence of hypertensive syndrome ( persistent increase in intracranial pressure).
• Disability group 2– assigned to patients who have progression of the disease, frequent exacerbations, persistent visual impairment ( decreased acuity and narrowing of visual fields). Also in such patients one can observe the frequent development of epileptic ( convulsive) seizures, disorder vestibular function (coordination of movements).
• 1st disability group– assigned to patients who develop complete blindness or a significant decrease in hearing, visual acuity and a sharp narrowing of visual fields. At the same time, patients cannot do without outside help, there is a limitation in the ability to navigate in space and self-service.

Patients with an established diagnosis of arachnoiditis are prohibited from physical and neuropsychic stress. Also, patients are contraindicated from working in unfavorable conditions ( noise, vibration, contact with toxic substances, altered atmospheric pressure). Some patients ( with attacks of convulsions, attacks of incoordination of movements) It is prohibited to work near moving mechanisms, at heights, or near fire. If the patient has impaired vision, work that involves eye strain or requires clear distinction of colors is contraindicated.

Every year, patients who have been assigned a disability group must undergo re-examination. In case of persistent and irreversible visual impairment, after a five-year observation, the disability group is established without specifying the period for re-examination. In case of positive changes in the dynamics of the disease, a change in the disability group is possible.

Why is smoking dangerous for arachnoiditis?

Smoking with arachnoiditis leads to a worsening of the patient's condition and irreversible changes in the brain. Nicotine contained in cigarettes affects not only the organs respiratory system, but also on organs that are damaged. In this case, such an organ is the brain, or rather its membranes. 8 - 10 seconds after the start of smoking, nicotine reaches the brain, where it begins to exert its harmful effects. Smoking leads to spasms ( narrowing) cerebral vessels. This leads to an additional increase in intracranial pressure, which is already present in arachnoiditis due to the formation of adhesions ( adhesions) and disturbances in the circulation of cerebrospinal fluid. Also, when smoking, blood circulation is impaired, which leads to impaired oxygen delivery and, accordingly, insufficient oxygen supply to the brain. Since the cells of the nervous system are the most sensitive to a lack of oxygen, they are the first to react to such changes, which leads to hypoxia ( oxygen starvation). For a long time oxygen starvation Intense headaches, memory impairment, and impaired coordination of movements develop. Since these symptoms are observed with arachnoiditis even without smoking, their manifestation is even more pronounced in smokers.

Long-term smoking leads to impaired elasticity of the walls of blood vessels. They become less elastic and weak. Increases the likelihood of cholesterol deposits ( atherosclerotic plaques) on the walls of blood vessels, which will further aggravate the blood supply to the brain. Smoking is a powerful poison that has a toxic effect not only on the brain, but also on other organs. In smokers with brain pathology ( cerebral arachnoiditis) the symptoms of the underlying disease manifest themselves to a greater extent, the disease progresses. There was a more frequent development of complications and less effective results ongoing treatment.

Arachnoiditis is an autoimmune pathology, characterized by damage to the arachnoid membrane of the brain and the formation of cysts in it. The main reason development become infectious diseases. Treatment mainly occurs through the use of medications.

What is arachnoiditis

The human brain consists of hard and soft membranes, between which the arachnoid is located, which is not part of them, but is tightly adjacent. The arachnoid membrane does not cover the gyri. Under it, in this area, a space is formed in which cerebrospinal fluid is located.

Under the influence of various factors, antibodies begin to form, which become the cause of the development of the inflammatory process. On the arachnoid membrane with arachnoiditis, opacities and thickening of the walls are observed, as well as the development of adhesions and cystic formations.

The presence of adhesions leads to obliteration of the cerebrospinal fluid pathways. As a result of these changes, hydrocephalus develops.

Arachnoiditis is a fairly serious disease that requires immediate treatment. Lack of therapy can lead to disability.

Types of disease

Depending on where the pathological process develops, experts distinguish several types of arachnoiditis.

Cerebral

Characterized by inflammation of the lining of the brain, consisting of blood vessels. Often the focus of the disease is located on the convex part, in the rear wall or at the base.

Cerebral arachnoiditis becomes the basis for headaches, which increase during prolonged exposure to cold air, as well as after mental or physical activity.

Neurological signs depend on the location of the inflammatory process. In some cases, the development of convulsive attacks is noted, during which the patient loses consciousness.

When the cerebrospinal fluid begins to put pressure on the motor and sensory centers of the brain, motor activity disorders develop and sensitivity decreases. This form, in turn, is divided into convexial and basal.

Optical-chiasmatic

In medicine it is also called post-traumatic. The disease often develops after a traumatic brain injury, and is also a complication after malaria, tonsillitis or syphilis.

The focus of inflammation is located near the inner part of the chiasm and optic nerves. As the lesion spreads, cysts and adhesions begin to form. When diagnosed, in some cases, neuritis and signs of stagnation are established. Opticochiasmatic arachnoiditis is characterized by headache, nausea and vomiting.

Spinal

The cause of the development of this form of arachnoiditis is abscesses, injuries, and furunculosis. The inflammatory process affects back wall brain. Clinical signs diseases appear some time after injury. Symptoms for the spinal type of pathology are pain syndrome, in which pain radiates to the lower and upper extremities.

Adhesive

In this case, the disease is characterized by the development of purulent inflammation, which is the cause of adhesions. Adhesive arachnoiditis also develops as a result of injuries and is considered a complication after infectious diseases.

Cystic

Inflammation is accompanied by the formation of cysts. One of characteristic symptoms are headaches that are bursting in nature and pronounced.

Cystic-adhesive

The formation of adhesions and cysts occurs as a result of the adhesion of the choroid and pia mater of the brain. Against this background, convulsive seizures develop. In medical practice, cases of loss of consciousness during attacks are often observed.

Treatment of arachnoiditis largely depends on the type and location of the pathological process. Only timely therapy will help avoid development severe consequences. That is why it is necessary to fully treat all infectious diseases and carefully monitor your health after injuries.

Clinical manifestations

From the point of view of clinical manifestations, the pathology manifests itself in the form of an asthenic or neurasthenic syndrome. In addition, there are lesions of the nerve endings that are located in the skull and are responsible for many processes occurring in the brain, cerebellar disorders, pyramidal disorders and focal signs.

The manifestation of symptoms directly depends on which part of the brain the inflammation occurs in. When making a diagnosis, the psychological and neurological condition of the patient is taken into account. In addition, an examination by an ophthalmologist and otolaryngologist is prescribed.

Today, there are two main types of the disease: true and residual. True arachnoiditis is diffuse in nature. A feature of this type is its fast flow. Unlike other types, the inflammatory process spreads to other brain tissues much faster, which leads to disability.

The residual differs significantly from the true one. The disease is local in nature and is not accompanied fast current. The pathology develops quite slowly. This type most often observed in young children and men under 40 years of age. Women suffer from arachnoiditis half as often as males.

Causes

The main cause of the pathology is various types of brain injuries or previous infectious diseases. The basis for the development of the inflammatory process may be:

1. Measles. A fairly common disease, one of the consequences of which can be arachnoiditis.
2. Flu. Every person has suffered from this disease. It is caused by viruses that provoke inflammation. If the disease is not treated in time, the pathological process spreads to areas of the brain.
3. Meningitis, which is viral in nature. Meningitis is characterized by inflammation that can affect certain areas of the brain.
4. Wind smallpox Many people don't think dangerous disease, but in some cases, the chickenpox virus can trigger the development of arachnoiditis.

In addition, the disease can occur as a result purulent inflammation, which are chronic in nature, and foci form in the skull. These include:

1. Otitis. A pathological process that occurs in the ear cavity, if left untreated, spreads to the brain tissue.
2. Sinusitis and rhinitis. Pus forms in the nasal cavity.
3. Mastoiditis. Inflammation is observed in the temple area. The cause of development is various infectious diseases of the ears.
4. Tonsillitis.
5. Infectious diseases in the oral cavity. These also include various diseases of the gums and teeth, which are characterized by inflammation and the formation of pus.

Arachnoiditis in 30% of cases begins to develop as a result of traumatic brain injury. This occurs in cases where the injury is accompanied by significant hemorrhage.

In medical practice, there are also cases when doctors cannot determine the exact cause of the pathology. Based on the data obtained, after many years of research, specialists were able to establish a number of factors that can trigger the development of arachnoiditis.

These include:

1. Frequent colds.
2. Intoxication after drinking alcohol or prolonged use of drugs.
3. Weakening of the body's protective functions.
4. Chronic fatigue. It often causes vegetative-vascular dystonia, which is characterized by impaired blood circulation to the brain. This may be the basis for the development of arachnoiditis.
5. Difficult working conditions.

Timely treatment of colds and maintaining immunity will help to avoid the development of pathology.

Symptoms

One of the most common symptoms of arachnoiditis is headache, which can manifest itself in different ways. Most often, there are sharp and sharp pains that occur with increased intracranial pressure. They can also be bursting. In rare cases, it is impossible for the patient to determine the location of the pain, when it seems that the whole head hurts.

During the day, the headache can change in nature, for example, in the morning the pain is stronger, and in the evening it weakens significantly. It may also subside after changing body position. Headaches often worsen during exercise or overexertion. The peak of pain in some cases is accompanied by vomiting and nausea.

In addition, patients usually complain of regular dizziness, which is irregular in nature and appears in the absence of various pain, as well as when the weather changes or after physical exertion.

Signs of the disease appear depending on the degree of damage to brain tissue. The main symptoms of arachnoiditis include:

1. General weakness. Patients have no desire to communicate even with relatives or perform professional duties, as they lack the strength to do so. Over time, they withdraw into themselves, become irritable and easily succumb to apathy.
2. Sleep disturbance. Insomnia often accompanies a person with arachnoiditis. But in some cases, patients fall asleep well, but have nightmares.
3. Promotion temperature bodies. May be insignificant, depending on the stage of the inflammatory process.
4. Decline concentration, memory impairment. It is observed when the pathological process affects the areas of the brain responsible for thinking and memory. Often such patients do not remember events that happened several hours ago.
5. Acrocyanosis. The upper layer of the epidermis begins to acquire an unusual bluish tint.
6. Frequent urination.
7. Cramps. Under certain circumstances, they can develop into seizures, when a person loses consciousness.
8. Quality violation hearing
9. Loss sense of smell. May be complete or partial.
10. Long lasting and frequent pain in the lumbar region.
11. Numbness limbs, temporary paralysis.
12. Level reduction potency.

Signs of the disease appear depending on the extent of the pathological process. If symptoms occur, you should contact a specialist who, based on diagnostic data, will determine a diagnosis and prescribe a treatment regimen.

Diagnostics

Diagnosis of arachnoiditis includes consultation with specialists and instrumental examination methods. If a pathology is suspected, the doctor prescribes a consultation:

1. Ophthalmologist for fundus examination.
2. Otolaryngologist in order to identify foci of the pathological process or treat the consequences.
3. Psychiatrist for the purpose of assessing the patient's condition.

After establishing the patient’s condition, an instrumental examination is prescribed, which includes:

1. X-ray of the spine and skull.
2. Encephalography.
3. Lumbar puncture.
4. Magnetic resonance imaging of the brain.
5. Pneumoencephalography.

Complex diagnostic measures allows you to determine the focus of the inflammatory process and the degree of damage to areas of the brain. Based on the data obtained, a course of treatment is prescribed.

Treatment

Treatment tactics are determined depending on the form and course of the pathology. In cases of severe and acute forms, therapy is carried out only in a hospital setting under the supervision of specialists.

For symptomatic treatment, hormonal, antibacterial and antiviral drugs are prescribed in small doses.

The drug is selected depending on the type of pathogen. To reduce swelling of brain tissue, it is prescribed antihistamines, as well as medications to stimulate brain function and reduce intracranial pressure.

To relieve symptoms, the following groups of drugs are indicated:

1. Analgesics to reduce pain.
2. Antiepileptics to correct behavioral characteristics.

Drug therapy, when administered on time, allows the patient to return to an almost normal life. Surgical intervention is prescribed in cases where medications do not have the desired effect, as well as when an opto-chiasmal type is established.

A direct indication for surgery is also the cystic form, since drugs only relieve symptoms, but are not a solution to the problem.

Complications, consequences, disability

To the main consequences and complications in the case of untimely treatment relate:

1. Decreased visual function.
2. The occurrence of hydrocephalus.
3. Development of convulsive seizures.

Patients with established arachnoiditis are usually assigned the second and third disability groups. The second is determined by those patients who experience frequent epileptic seizures, and visual acuity is reduced to 0.08 with correction.

The first disability group is assigned to the patient in cases where there is severe course optico-chiasmal form of the disease, accompanied by complete blindness.

Prevention measures

Preventive measures include nonspecific and specific measures. Non-specific ones include:

1. Hardening.
2. Prevention infectious diseases, which involves timely vaccination and taking vitamin complexes.
3. Keeping healthy lifestyle. At the same time, it is necessary to give up bad habits.
4. Regular examinations at the ophthalmologist.
5. Timely detection and treatment of craniocerebral injuries

Specific preventive measures include:

1. Full prevention diseases and examinations for traumatic brain injuries.
2. Regular examination to avoid relapse.

Arachnoiditis is a serious disease that requires immediate treatment. The causes of development are infectious diseases and skull injuries. In order to prevent the recurrence of the pathology after successful treatment, it is necessary to regularly visit the doctor and undergo examinations.

Autoimmune inflammatory lesion arachnoid membrane of the brain, leading to the formation of adhesions and cysts in it. Clinically, arachnoiditis is manifested by liquor-hypertension, asthenic or neurasthenic syndromes, as well as focal symptoms (damage to cranial nerves, pyramidal disorders, cerebellar disorders), depending on the predominant localization of the process. The diagnosis of arachnoiditis is established on the basis of anamnesis, assessment of neurological and mental status patient, Echo-EG, EEG data, lumbar puncture, ophthalmological and otolaryngological examination, MRI and CT of the brain, CT cisternography. Arachnoiditis is treated mainly with complex drug therapy, including anti-inflammatory, dehydration, antiallergic, antiepileptic, absorbable and neuroprotective drugs.

General information

Arachnoiditis of the posterior cranial fossa often has a severe course, similar to brain tumors of this location. Arachnoiditis of the cerebellopontine angle, as a rule, begins to manifest as damage to the auditory nerve. However, it may begin with trigeminal neuralgia. Then symptoms of central neuritis of the facial nerve appear. With arachnoiditis of the cistern magna, a pronounced liquor-hypertensive syndrome with severe liquor-dynamic crises comes to the fore. Cerebellar disorders are characteristic: coordination disorders, nystagmus and cerebellar ataxia. Arachnoiditis in the area of ​​the cistern magna can be complicated by the development of occlusive hydrocephalus and the formation of a syringomyelitic cyst.

Diagnosis of arachnoiditis

A neurologist can establish true arachnoiditis only after a comprehensive examination of the patient and comparison of anamnestic data, the results of a neurological examination and instrumental studies. When collecting anamnesis, attention is paid to the gradual development of symptoms of the disease and their progressive nature, recent infections or traumatic brain injuries. A study of the neurological status makes it possible to identify disorders of the cranial nerves, determine focal neurological deficits, psycho-emotional and mnestic disorders.

Lumbar puncture provides accurate information about the amount of intracranial pressure. Examination of the cerebrospinal fluid in active arachnoiditis usually reveals an increase in protein to 0.6 g/l and in the number of cells, as well as increased content neurotransmitters (eg serotonin). It helps differentiate arachnoiditis from others cerebral diseases.

Treatment of arachnoiditis

Treatment for arachnoiditis is usually carried out in a hospital. It depends on the etiology and degree of disease activity. The drug treatment regimen for patients with arachnoiditis may include anti-inflammatory therapy with glucocorticosteroid drugs (methylprednisolone, prednisolone), absorbable agents (hyaluronidase, quinine iodobismuthate, pyrogenal), antiepileptic drugs (carbamazepine, levetiracetam, etc.), dehydration drugs (depending on the degree of increase intracranial pressure - mannitol, acetazolamide, furosemide), neuroprotectors and metabolites (piracetam, meldonium, ginkgo biloba, pig brain hydrolysate, etc.), antiallergic medications (clemastine, loratadine, mebhydroline, hifenadine), psychotropics (antidepressants, tranquilizers, sedatives) . An obligatory point in the treatment of arachnoiditis is the sanitation of existing foci of purulent infection (otitis media, sinusitis, etc.).