Pseudomeningocele as a result of traumatic nerve root avulsion

Abstract

A 23-year-old man presented with weakness of shoulder abduction and elbow flexion on the right side, with numbness of the index finger and thumb, after a bike accident. On examination, he had grade II/V power of the deltoid and biceps, with absent biceps jerk and sensory impairment in the C5–C6 dermatomes. Considering a traumatic cervical radiculopathy or brachial plexus injury, magnetic resonance imaging of the cervical spine and brachial plexus was taken, which showed cerebrospinal fluid collection lateral to the spinal cord and extending to the neural foramina, with denervation changes in the right paraspinal muscles, such as the multifidus muscle, suggestive of C6 root avulsion with pseudomeningocele (Fig. 1a,b). Pseudomeningocele is an extravasated collection of extradural cerebrospinal fluid that results from a dural tear, which unlike true meningocele, is not lined by arachnoid cells. Traumatic pseudomeningocele occurs after injuries to the brachial or lumbosacral plexus. Magnetic resonance imaging is the diagnostic modality of choice, which shows cerebrospinal fluid density adjacent to and in connection with the thecal sac.1 The prognosis of this type of nerve injury is poor. Nerve transfer techniques using spinal accessory or intercostal nerves are effective in such cases.2 The authors declare no conflict of interest.