adhesive arachnoiditis in week 1 or 2 - too soon to tell?

[sidg-1]

So, funny story - my brother was doing some stuff on his bed while popping a squat on the very edge, back to the precipice, obviously. Predictably, his balance went backwards and he fell, each cheek landing on two separate, solid crates of art stuff he kept right on bedside. He shook it off and proceeded with his day, thinking nothing of it.

Couple of days later, he walks to the gym and does some running and assisted dips. He starts to get a painful headache, severe dizziness and throws up. He has to be driven back. The symptoms keep looping at home periodically.

The initial guess is the dips pinched a nerve or pulled a muscle in the neck/upper back, so we approach a physiotherapist. There’s relief for the first 2 days. Then they try to stretch the neck a little too much and outta nowhere, a new gate of pain opens! Now debilitating pain starts radiating from the lower back up into the neck/head, causing the same immobilization, dizziness and nausea. So there are now TWO spots of misery.

After six days of running around and a consult with an orthopedic spine surgeon, we get an MRI screening.

Straightening in the cervical spine, posterior marginal osteophytes at c5-c6, c7-d1. Not so concerning?

Now the lumbar spine… There’s straightening there too, along with a lot more marginal posterior osteophytes. Some mild posterior disc bulges indenting over ventral thecal sac, but no neural compression, so yay.

The thing the radiologist bolded and underlined, though, is the cauda equina nerve roots appearing abnormally clumped and crowded predominantly in the dependent posterior aspect of the thecal sac. They think it’s likely adhesive arachnoiditis, pending further analysis by contrast enhanced MRI of lumbar spine.

Is it a little too soon to tell whether the injury/injuries are resulting in any kind of arachnoiditis? It’s been a week since severe symptoms, probably under two weeks since the fall.

I don’t necessarily like the idea of a contrast enhanced MRI if that involves an epidural or injection into the arachnoid mater. At least Dr. Google seems to suggest that this could risk nerve ossification if this is indeed the condition . Will just a second opinion be better?

Thank you so much for coming to Evanston, Chicago !

[Austin_Baraki]

Hi there

Sorry to hear about this situation. There’s a lot here that I find very unusual.

It’s not clear what his predominant, current symptoms are. Adhesive arachnoiditis typically is a more slowly-developing condition, and if it is suspected in the cauda equina nerve roots, I would expect symptoms in the low back, legs, and potentially impacting bowel & bladder function – it would not itself cause symptoms like headache, dizziness, nausea/vomiting.

It’s important to take radiology reports with a grain of salt – especially when they are based on scans that are not “optimal” for the suspected condition (in this case, a non-contrasted MRI). The ordering clinician always has to take the report and interpret the findings in the context of the patient in front of them, to see whether it actually makes sense. So, yes, getting additional physician opinions will be important.

Regarding the scan, a “contrast-enhanced MRI” means an MRI scan with gadolinium contrast administered by IV. It is not injected into the epidural space, and it is not possible to inject contrast into the arachnoid. The type of scan involving contrast injected into the spinal canal is called a myelogram – which is sometimes necessary as well.

[sidg-1]

Thank you very much for the valuable insight!

At what stage would you advice starting some semblance of recovery and rehabilitation activities?

Right now, the best he can can manage to tolerate is heating pads, very slow and short walks, and, maybe, gentle back massages while seated. Both cervical and lumbar mobility are largely limited now, unless the painkillers make him feel invulnerable again. Everything’s WAY worse after those brief shenanigans .

And just so my dear numb-nuts (pardon my french, and really hope it doesn’t actually come to that…) learns a thing or two, can you, pretty please, elaborate on how smoking and nicotine will impact nerve recovery ?

[Austin_Baraki]

At what stage would you advice starting some semblance of recovery and rehabilitation activities?

Right now, the best he can can manage to tolerate is heating pads, very slow and short walks, and, maybe, gentle back massages while seated. Both cervical and lumbar mobility are largely limited now, unless the painkillers make him feel invulnerable again. Everything’s WAY worse after those brief shenanigans .

Giving him specific advice in the context of what you laid out in the original post is outside the scope of what we can do via the forum, unfortunately. There’s too much additional context and clinical information still needed. I’d suggest getting your additional/”second opinion” physician evaluations, considering the contrasted MRI if they agree it’s needed, and if you’d like more specific rehab guidance, setting up a consult with our rehab team would be appropriate.

And just so my dear numb-nuts (pardon my french, and really hope it doesn’t actually come to that…) learns a thing or two, can you, pretty please, elaborate on how smoking and nicotine will impact nerve recovery ?

Smoking makes pretty much everything worse, including back pain. Quit Smoking to (Slowly) Treat Chronic Pain

[sidg-1]

Thank you for not closing this thread.

Following up on my brother’s diagnosis, turns out it was a stroke.

We only figured out it was something serious when he started having speech problems after a week, so, know the symptoms, people. He’s only 35, was living an active lifestyle, maybe slightly overweight by BMI. So an aneurysm at the gym was not on the bingo cards of anyone looking at his case. Not catching it early also caused more clotting in the brain, shrinking of damaged arteries, so the hospital stay has to be extended for some supervised healing before any surgery can be considered.

And definitely don’t smoke, kids . Even if he can’t remember where he lives or my government name, the dude still doesn’t forget to ask for a cig .