Spinal meningitides with radiculo-myelopathy: Part 1. Clinical and radiological features

Abstract

1. (1) Seventy cases of spinal leptomeningitis or "arachnoiditis" with radiculomyelopathy are described. 2. (2) The cases were divided into 3 main groups: (i) 19 cases with known aetiological factors including disc prolapse, etc. (Group 3); (ii) 18 cases with spinal leptomeningitis following tuberculous cranial meningitis (Group 2); (iii) 33 cases in which initially the mechanism was unclear, but which were subsequently shown to be a result of tuberculous spinal meningitis (subgroup 1A, 20 cases), or "idiopathic" (subgroup 1B, 13 cases). 3. (3) The 20 cases of subgroup 1A are analysed in detail. In the majority of these, the onset was rapid with malaise, root pains, paralysis and paraesthesiae, related to localised or diffuse cord involvement. CSF and myelographic evidence of block were manifest in most. The leptomeningitis was often more widespread than the clinical features of the myelopathy indicated. 4. (4) The association with tuberculosis elsewhere in the body, the response to anti-tuberculous treatment and the later development of tuberculous meningitis all pointed to a tuberculous aetiology in cases of Group IA and this was at times confirmed pathologically (see Dastur and Wadia 1969).