Cervical pseudomeningocele-induced hydrocephalus following traumatic brachial plexus injury-Ã¢ÂÂa case reportSara Ganaha1, Montserrat Lara-Velazquez1, Jang W Yoon1, Peter M Murray2, Oluwaseun O Akinduro1 and Gordon H Deen1*
- *Corresponding Author:
- Gordon H Deen
M.D., Department of Neurosurgery
Mayo Clinic, 4500 San Pablo Rd.
Jacksonville, FL 32224, USA
E-mail: [email protected]
Received date: March 17, 2017; Accepted date: March 25, 2017; Published date: March 27, 2017
Citation: Ganaha S, Lara-Velazquez M, Yoon JW, Murray PM, Akinduro OO, et al. (2017) Cervical Pseudomeningocele-Induced Hydrocephalus Following Traumatic Brachial Plexus Injury â A Case Report. J Spine 6:362. doi: 10.4172/2165-7939.1000362
Copyright: © 2017 Ganaha S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Introduction: We report a case of a 49-year-old man who sustained a left brachial plexus injury and traumatic brain injury after a motor vehicle accident and subsequently developed a giant left cervical pseudomeningocele. The patient suffered multiple fractures in the cervical and thoracic ribs, transverse processes and the scapula. Physical examination revealed a giant left supraclavicular mass restricting his ability to turn his head ipsilaterally, with head tilted to the right, consistent with complete plexus avulsion. Neurological examination showed progressive muscular atrophy and a positive Tinel’s sign and paresthesias of the left hand. Methods: MRI and CT revealed a giant cervical pseudomeningocele. Left hemilaminectomy and partial medial facetectomy were performed for an extradural repair of the cyst. Three days later, the pseudomeningocele recurred; C6-T2 cervical laminectomy and a combined intra- and extradural repair of CSF leak with tensor fascia lata graft were performed. One day after the second surgery, the patient developed acute communicating hydrocephalus (CH) with progressive neurological decline. Results: Ventriculoperitoneal shunt placement successfully resolved neurological symptoms associated with CH. The patient continued receiving treatment for neuropathic pain and spams in the left upper arm at one-year follow up. Conclusion: We present one of the few documented cases of acute CH after a successful repair of a giant cervical pseudomeningocele. It is important for physicians to be aware of changes in CSF flow dynamics that occur in patients with traumatic brain injury. A repair of a large chronic pseudomeningocele can lead to acute CH in patients and cause rapid neurological decline. It is critical for clinicians to be mindful of the potential complication of acute hydrocephalus in patients who undergo repair of a large chronic pseudomeningocele secondary to trauma.