COLUMNA VERTEBRAL
MRI CORD OEDEMA FROM CYSTIC ARACHNOIDITIS
CORD OEDEMA FROM CYSTIC ARACHNOIDITIS
Spinal arachnoiditis can have various appearances. One of the more severe forms, cystic arachnoiditis, can result in cord signal abnormality which can be very extensive. This post looks at why cord oedema develops in cystic arachnoiditis and its MRI appearance.
- Normally there is two way flow of CSF between the central canal/ cord and the subarachnoid space and vice versa. Overall net flow is into the cord.
- Arachnoiditis can result in septations, intra dural arachnoid cyst formation and tethering of the cord.
- Cord tethering and septations can result in abnormal CSF flow dynamics with net increase in fluid and interstitial pressure in the cord which can lead to syrinx formation, cord oedema or both.
- Cord oedema and syrinx formation may begin at the level of the septation or cyst but can be extend quite distant to them.
Image Above: Cystic changes and septation in the lumbar thecal sac. Normal distribution of nerve roots not seen.
Image Above: Subarachnoid cystic change with cord compression secondary to cystic arachnoiditis.
Image Above: Cystic arachnoiditis with cord oedema. Cystic subarachnoid change (blue arrows). Extensive cord oedema (yellow arrows) secondary to altered CSF flow and fluid accumulating in the cord.
Cystic arachnoiditis is a severe form of spinal arachnoiditis that can result in cord signal abnormality, such as cord oedema, due to abnormal CSF flow dynamics from the result of cord tethering and septations.
Normally, there is a two-way flow of CSF between the central canal/cord and the subarachnoid space, and overall net flow is into the cord.
Arachnoiditis can result in septations, arachnoid cyst formation, and cord tethering. This can result in abnormal CSF flow dynamics and net increase of fluid and interstitial pressure in the cord, leading to syrinx formation, cord oedema, or both.
Cord tethering is the attachment of the spinal cord to the surrounding tissues, which can occur due to the formation of septations or arachnoid cysts. This can contribute to abnormal CSF flow and lead to syrinx formation, cord oedema, or both.
The MRI appearance of cystic arachnoiditis can show subarachnoid cystic changes with cord compression, and in severe cases, extensive cord oedema due to altered CSF flow and fluid accumulation in the cord.
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