Chronic spinal meningitis: a forgotten condition revisited through a case series and literature review

Chronic spinal meningitis, marked by inflammation of the spinal cord’s meninges, poses significant diagnostic and therapeutic challenges, particularly when the cause remains unidentified. This case series reviews four patients presenting with chronic spinal meningitis, showcasing diagnostic strategies, clinical courses, and management difficulties. The study highlights the need for a comprehensive, multidisciplinary approach involving neurologists, infectious disease experts, and rheumatologists. Despite advances in imaging and cerebrospinal fluid (CSF) analysis, definitive diagnosis often remains elusive. Cases progress to complications such as hypertrophic spinal pachymeningitis and spinal adhesive arachnoiditis, which may lead to severe long-term sequelae. A detailed analysis of each patient demonstrated the complexities of differential diagnosis, with conditions ranging from infectious and autoimmune disorders to carcinomatous meningitis. This series emphasizes the necessity of heightened clinical awareness, comprehensive diagnostic approaches, and further research to address the knowledge gap in chronic spinal meningitis and improve patient outcomes through timely intervention.