title: Thoracic arachnoiditis, arachnoid cyst and syrinx formation secondary to myelography with Myodil, 30 years previously.
abstract: Spinal arachnoiditis can rarely occur following irritation from foreign body substances, including certain oil based contrast agents used for myelography. We describe a patient with thoracic arachnoiditis, arachnoid cyst and syringomyelia, 30 years following a myelogram with Myodil. A 62-year-old female presented with chronic thoraco-lumbar back pain, a spastic paraparesis and sphincter disturbance. She had undergone a myelogram with Myodil, 30 years previously for investigation of back pain. A MRI scan revealed evidence of arachnoiditis, thoracic syringomyelia (T6-T8) and an anteriorly placed, extramedullary, arachnoid cyst at T10-T12, compressing the cord. At surgery, T7-T10 thoracic laminectomies were carried out and syringo- and cysto-subarachnoid shunts were inserted. At 12 months follow-up, the sphincter disturbance, lower limb weakness and mobility problems had almost resolved. Although, the use of oil based contrast agents such as Myodil has been discontinued, the present case illustrates some of the rare sequelae of its use, manifesting decades later. Aggressive surgical intervention produced symptomatic benefit.
authors.affiliation: Department of Neurosurgery, Greater Manchester Neuroscience Centre, Hope Hospital, Stott Lane, Salford, M6 8HD, Manchester, UK. kanna.gnanalingham@srht.nhs.uk
authors.forename: Kanna K
authors.initials: KK
authors.lastname: Gnanalingham
authors.forename: Shabin Man
authors.initials: SM
authors.lastname: Joshi
authors.forename: Ian
authors.initials: I
authors.lastname: Sabin
mesh_terms: D016080:Arachnoid Cysts / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D001100:Arachnoiditis / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007481:Iophendylate / Q000009:adverse effects*; D017116:Low Back Pain / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008499:Medical Records; D008875:Middle Aged; D019635:Neurosurgical Procedures; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology; D013595:Syringomyelia / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D013904:Thoracic Vertebrae; D013997:Time Factors
chemical_list: D003287:Contrast Media; D007481:Iophendylate