Clinical symptoms in patients with arachnoiditis
J.A. Aldrete1, Valentina T. Aldrete2, L.A. Vascello3, J.C. Zapata4, T. Brown5, B. Decker6
1) Department of Anesthesiology, University of South Florida, Tampa. 2) Aldrete Pain Care Center; Seaside, Florida. 3) Department of Anesthesiology, Chandler Medical Center, University of Kentucky, Lexington, Kentucky. 4) Department of Anesthesia, Massachusetts General Hospital, Boston. 5) Diagnostic Imaging Center, Pensacola. 6) Panama City, Florida, USA
Abstract
Objectives: To identify the most frequently noted symptoms in patients with lumbar arachnoiditis (ARC).
Design. Prospective review of medical records.
Setting. Ambulatory pain clinic facility.
Subjects. 70 adult patients (40 men, 30 women) with radiologically confirmed ARC by either MRI or myelogram followed by CAT scan.
Outcome measures. The location, the characteristics and the type of pain, sensory abnormality and frequency of muscle spasms where noted as well as other symptoms such as headache profuse diaphoresis, insomnia, bladder, bowel, unisexual dysfunction. The personal habits, work status, disability, physical activities and participation in litigation procedures where also recorded.
Results. Severe burning, low-back pain was present in 96%, radiating toward the lower extremities in 70% of them; segmental numbness, tingling, hypoesthesia and dysesthesia were common. Ninety eight per cent complained of muscle spasms. Low grade fever, headaches, fatigue, heat intolerance and diaphoresis were noted in more than 65% of the patients. Bladder dysfunction was present mostly in women. Sexual dysfunction such as loss of libido, impotence, pain during and after intercourse were present frequently.
Conclusions. Certain skepticism has been expressed concerning the distribution of the pain and sensory alterations reported by patients with ARS. This is probably due to the type and location of the lesions involving nerve roots, dural sac and some times spinal cord with profound disarray of the nociceptive pathways and receptor hypersensitivity that appears to be present in ARC. The symptoms herein described, when present in a patient that may have had an injurious event to the spine, should alert physicians as to the presence of ARC, which needs to have diagnostic imaging confirmation.
Key words: symptoms, arachnoiditis, neuropathic pain, dysesthesia
Jurnalul Român de Anestezie Terapie intensivă 2002 Vol.9 Nr.1, 5-14
STUDII CLINICE
Clinical symptoms in patients with arachnoiditis
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