P.132 Post-traumatic spinal pseudomeningocele with delayed neurological deterioration

Abstract

Background: Post-traumatic spinal pseudomeningoceles are uncommon sequelae of brachial plexus injuries. These cerebrospinal fluid (CSF) collections have rarely been described to occur within the spinal canal with resultant cord compression and neurological deficit. We present the case of an intracanalicular pseudomeningocele causing spinal cord compression and progressive radiculomyelopathic weakness more than a decade after the original injury. Methods: Case report and review of the literature. Results: A 34 year old man presented with progressive cervical radiculomyelopathy 16 years after sustaining a brachial plexus avulsion injury. Magnetic resonance imaging revealed an anterior epidural intracanalicular fluid collection from C3 to L3, with focal compression at the cervicothoracic junction. Surgical intervention involved a C7 to T3 laminectomy and fenestration of the anterior dura to permit communication of CSF between the dural space and pseudomeningocele. His strength and dexterity improved dramatically post-operatively. Conclusions: Spinal pseudomeningoceles following a traumatic brachial avulsion injury are typically found outside the spinal canal and are usually not associated with any neurological symptoms. There are few reported cases of post-avulsion intracanalicular pseudomeningoceles which present with delayed spinal cord compression and neurological dysfunction. Therefore, patients with a history of a traumatic avulsion injury and delayed neurological symptoms should warrant additional investigations.