POST TRAUMATIC PSEUDOMENINGOCELE

Abstract

A case of traumatic avulsion of the brachial plexus presenting as multiple cervical pseudomeningoceles following a fall from bicycle is presented. Two wheeler accidents may result in severe distraction of arm with dural tears. Overall they are rare causes of nerve root or spinal trauma. Case Report A 15-year-old boy presented with complaints of persistent loss of movement of right shoulder and right upper limb associated with loss of sensation along lateral aspect of upper arm and distal to the elbow following a fall from a bicycle 2 months ago. He had also fractured the olecranon process and the medial condyle of right side ulna and humerus respectively. These injuries were managed conservatively. On examination he had grade o/V power in muscle groups of the right shoulder with wasting of the supraspinatus, infraspinatus and deltoid, and winging of the right scapula. He had loss of sensation over C5-7 dermatomes. He was provisionally diagnosed as having right brachial plexus injury. Routine investigations were within normal limits. Myelogram revealed no obstruction to the flow of contrast in the spinal subarachnoid space. A bulbous outpouching was seen emerging from the right sided neural foramen C5-6 in both frontal and lateral projections. This was followed by computed tomomyelography (CTM) of the cervical spine from C2 to T1 levels with 5 mm sections at vertebral body level and 1 mm sections at disc level. The study revealed anteroposterior compression fracture of the body of C7 with a chip fragment lying on the right side. There was a tear of right root sleeve at C7-T1 disc level resulting in formation of a post traumatic pseudomeningocele extending over a length of 1.85 cm having a width of .45cm (Fig 1). There was also pressure effect on right anterolateral aspect of thecal sac at this level. There was another root sleeve tear at the level of C5-6 with a relatively smaller pseudomeningocele protruding from the right neural foramen (Fig 2). Open in a separate window Fig. 1 CTM reveals anteroposterior compression fracture of body of C7 vertebra with pseudomeningocele (arrows) at C7-T1 level.