From the Department of Neurology (P.K., L.K., J.M.B.); and Department of Neurosurgery (P.K., J.M.B.), Yale School of Medicine, New Haven, CT; Department of Neurosurgery (P.K., N.T.), Ludwig-Maximilians-University Munich; and Department of Neurology (L.K.), Heidelberg University Hospital, Germany.
Neurology. 2022 Feb 1;98(5):208-213. doi: 10.1212/WNL.0000000000013085. Epub 2021 Nov 19.
A 64-year-old man presented for evaluation of proximally pronounced weakness of the arms with preserved facial and lower extremity strength. Symptoms slowly developed over the last 2 years, and the patient's history was notable for severe meningitis 4 years before presentation, which was adequately treated with antibiotics. On examination, symptoms clinically reassembled man-in-the-barrel syndrome and localized to the cervicothoracic central cord. Blood analysis was unremarkable, and CSF analysis showed no recurrent or persistent infection. Spinal MRI revealed pockets of sequestered CSF from C3 to C4 and areas of CSF space effacement from C3 to T12. MRI findings were interpreted as cord tethering suggestive of adhesive arachnoiditis. CT myelogram showed insufficient contrast agent migration above T10 and contour irregularities of the conus medullaris, confirming the postulated pathomechanism of cord tethering. Final diagnosis was therefore cervicothoracic central cord damage due to cord tethering in the setting of postinfectious adhesive arachnoiditis following bacterial meningitis. The patient failed a course of pulsed methylprednisolone therapy, and symptoms progressed. Best supportive care was provided. The clinical presentation of adhesive arachnoiditis is variable, and advanced imaging techniques and invasive studies such as CT myelogram may be required to establish the diagnosis. Timely diagnosis is warranted as early surgical or medical therapy can improve symptoms.
一位 64 岁男性，因上肢近端无力就诊，面部和下肢肌力保留。症状在过去 2 年内逐渐出现，病史中有 4 年前曾患严重脑膜炎，经抗生素充分治疗。体格检查发现，症状符合桶柄样综合征，局限于颈胸段中央索。血液分析无明显异常，CSF 分析未显示复发性或持续性感染。脊髓 MRI 显示 C3 至 C4 段有封闭的 CSF 袋，C3 至 T12 段有 CSF 空间消失。MRI 结果提示为脊髓栓系，提示粘连性蛛网膜炎。CT 脊髓造影显示 T10 以上造影剂迁移不足，圆锥形态不规则，证实了脊髓栓系的假设发病机制。最终诊断为细菌性脑膜炎后继发感染性粘连性蛛网膜炎导致颈胸段中央索损伤。该患者接受了脉冲甲基强的松龙治疗，但症状进展，给予最佳支持治疗。粘连性蛛网膜炎的临床表现多样，可能需要高级影像学技术和有创性研究（如 CT 脊髓造影）来确立诊断。及时诊断至关重要，因为早期手术或药物治疗可以改善症状。
