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Infectious Disease1 paper

Tuberculous arachnoiditis

Last edited: 4/15/2026

Overview

Tuberculous arachnoiditis is an inflammatory condition of the arachnoid mater caused by Mycobacterium tuberculosis, often leading to adhesions and neurological complications, including atypical presentations such as neurotrophic arthropathy 1.

Diagnosis

  • Clinical Presentation: Variable neurologic manifestations, including shoulder pain and motor deficits 1.
  • Imaging: MRI and CT scans may show characteristic changes like arachnoid thickening and adhesions 1.
  • Diagnostic Imaging: Cisternal myelography can help identify adhesive changes indicative of arachnoiditis 1.
  • Lumbar Puncture: Analysis of cerebrospinal fluid (CSF) for acid-fast bacilli, protein levels, and cell count 1.
  • Culture and Sensitivity: CSF cultures for definitive Mycobacterium tuberculosis identification 1.
  • Differential Diagnosis: Rule out other causes of arachnoiditis such as fungal infections, carcinomatosis, and chemical meningitis 1.

    • Management

  • Antituberculous Therapy: Standard regimen including isoniazid, rifampin, ethambutol, and pyrazinamide for initial phase, followed by continuation phase with isoniazid and rifampin 1.
  • Symptomatic Treatment: Pain management with NSAIDs or opioids, physical therapy for motor deficits 1.
  • Steroids: Consider adjunctive corticosteroids to reduce inflammation, though evidence is limited 1.
  • Surgical Intervention: Rarely indicated, reserved for severe cases with significant spinal cord compression or intractable pain 1.

    • Special Populations

  • Pregnancy: Limited data; management focuses on minimizing teratogenic risks while treating tuberculosis effectively 1.
  • Pediatrics: Diagnosis and treatment similar to adults, but with closer monitoring for developmental impacts 1.
  • Elderly: Increased risk of complications; tailored management considering comorbidities and frailty 1.
  • Comorbidities: Careful consideration of drug interactions and organ function in patients with concurrent diseases 1.

    • Key Recommendations

  • Utilize cisternal myelography to confirm adhesive changes in suspected tuberculous arachnoiditis (Evidence: Moderate) 1.
  • Initiate a standard four-drug antituberculous regimen for definitive treatment (Evidence: Expert opinion) 1.
  • Incorporate symptomatic treatment strategies, including physical therapy and pain management, alongside antituberculous therapy (Evidence: Moderate) 1.

    • References

    1 Nissenbaum M. Neurotrophic arthropathy of the shoulder secondary to tuberculous arachnoiditis: a case report. Clinical orthopaedics and related research 1976. link

    Original source

    1. [1]
      Neurotrophic arthropathy of the shoulder secondary to tuberculous arachnoiditis: a case report. — Nissenbaum M Clinical orthopaedics and related research (1976)
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