Acute hydrocephalus following cervical spinal cord injury

Abstract

We present a case of acute hydrocephalus secondary to cervical spinal cord injury in a patient with diffuse ossification of the posterior longitudinal ligament (OPLL). A 75-year-old male patient visited the emergency department with tetraparesis and spinal shock. Imaging studies showed cervical spinal cord injury with hemorrhage and diffuse OPLL from C1 to C4. We performed decompressive laminectomy and occipitocervical fusion. Two days after surgery, his mental status had deteriorated to drowsiness with dilatation of the right pupil. Findings on brain computed tomography revealed acute hydrocephalus and subarachnoid hemorrhage in the cerebellomedullary cistern, therefore, extraventricular drainage was performed immediately. Acute hydrocephalus as a complication of cervical spine trauma is rare, however, it should be considered if the patient shows deterioration of neurologic symptoms.

Keywords: Hydrocephalus; Ossification of the posterior longitudinal ligament of the spine; Spinal cord injuries.

Fig. 1

Preoperative cervical MRI. A : Sagittal cervical MRI revealing thick diffuse OPLL with cord compression and heterogeneous signal change from the cervicomedullary junction to the C4 level. B : Also, axial MRI reveals right side dominant spinal cord compression and signal change of the spinal cord. MRI : magnetic resonance imaging, OPLL : ossification of the posterior longitudinal ligament.

Fig. 2

Decompressive total laminectomy from C1 to C5, and occipitocervical fusion were performed.

Fig. 3

Brain CT shows marked enlargement of the lateral, third, and fourth ventricles. Also, SAH is observed in the cerebellomedullary cistern (arrows). CT : computed tomography, SAH : subarachnoid hemorrhage.