Exacerbation of chronic arachnoiditis as one of the causes of transient headache

Abstract

Arachnoiditis is an organic lesion of the brain, manifested as diffuse productive inflammation in the arachnoid membrane of the brain with the formation of adhesions and cysts, involving the pia mater, ependyma and subependymal layer of the ventricles and choroid plexuses in the pathological process. The incidence of the disease is approximately 3–5 % among all organic lesions of the central nervous system. Arachnoiditis can be autoimmune in nature, the pathogenesis of which is hyperproduction of autoantibodies followed by hyperplasia of the arachnoid endothelium as a result of their effect, or manifest itself as residual manifestations after a neuroinfection or traumatic brain injury. In most cases, focal symptoms accompanying arachnoiditis are associated with irritant action and involvement of the underlying brain structures in the adhesive process. The clinical picture is a complex symptom complex, including a combination of general infectious, cerebral, focal symptoms and signs of changes in the composition of the cerebrospinal fluid. Of the cerebral symptoms, headache comes first; it occurs in 80 % of patients with a history of arachnoiditis. The greatest intensity of the headache is noted in the early morning hours; very often it is accompanied by nausea and vomiting. In the vast majority of cases, this pain is based on intracranial hypertension. In addition to headaches, non-systemic dizziness is observed, and autonomic dysfunction and increased sensory excitability are noted in those suffering from chronic arachnoiditis.