Encasement of the Cauda Equina After Early Childhood Meningitis: Case Report and Review of the Literature

Abstract

Background: Arachnopathy following meningitis has been described in the setting of chronic spinal arachnoiditis and more recently as shunt-related progressive myelopathy due to meningeal thickening.

Case description: We describe an atypical case of a patient who presented with chronic arachnopathy 5 decades after an episode of meningitis. We also review the literature concerning arachnopathies occurring in the context of early childhood meningitis. Although our case bore clinical and radiologic similarities to chronic spinal arachnoiditis and shunt-related progressive myelopathy, time to symptom onset, intraoperative findings, pathophysiology, and surgical outcome set it apart from both conditions.

Conclusions: It is challenging but worthwhile to recognize this separate entity because, in contrast to both shunt-related progressive myelopathy due to meningeal thickening and adhesive arachnoiditis, surgery involving microsurgical dissection of the thick arachnoid encasement of the cauda equina may be curative in medically refractory cases.

Keywords: Cauda equina; Encasement; Late onset arachnopathy; Meningitis; Surgery.