Context: A patient followed in the outpatient spinal cord injury support clinic at a VA Medical Center with a prior remote history of a gunshot wound to the back and multiple prior myelograms presented with a recurrent waxing and waning weakness of the left lower extremity and intermittent incontinence of bowel and bladder.

Findings: During the evaluation, the patient experienced an immediate albeit temporary improvement in symptoms after a diagnostic lumbar puncture performed for CT myelogram. The symptoms of myelopathy reoccurred several weeks, but then the patient had a similar experience with rapid improvement in symptoms after an accidental fall down a flight of steps. Subsequently, the foot weakness and incontinence returned one week later. The patient ultimately developed permanent improvement in signs and symptoms after surgical intervention which included intradural lysis of adhesions, incision of the arachnoid membrane and resection of a cystic lesion.

Clinical relevance: Patients who experience unexpected, albeit transient improvement in myelopathic symptoms who are known or suspected to have arachnoiditis should be evaluated for surgically remediable lesions. Remediation of these lesions can potentially improve long term outcome.

背景：一名患者在 VA 医疗中心的门诊脊髓损伤支持诊所接受随访，既往有背部枪伤的远程病史和多次脊髓造影，表现为左下肢反复发作和减弱的无力和间歇性尿失禁肠和膀胱。

结果：在评估过程中，患者在进行 CT 脊髓造影的诊断性腰椎穿刺后症状立即得到改善，尽管是暂时的。脊髓病的症状在数周内再次出现，但随后患者在一次意外跌倒后出现了类似的症状快速改善的经历。随后，足部无力和失禁一周后复发。手术干预包括硬膜内粘连松解、蛛网膜切开和囊性病变切除后，患者最终出现了体征和症状的永久性改善。

临床相关性：对于已知或怀疑患有蛛网膜炎的脊髓病症状出现意外但短暂改善的患者，应评估可手术治疗的病变。修复这些病变可能会改善长期结果。