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. 2018:47:41-44.
doi: 10.1016/j.ijscr.2018.04.014. Epub 2018 Apr 22.

Lumbar pseudomeningocele presenting as decerebrate rigidity-A rare case entity

Satish Rudrappa  1 , Ramachandran Govindasamy  2 , Venkata Ramakrishna Tukkapuram  3 , Swaroop Gopal  4
Affiliations

Lumbar pseudomeningocele presenting as decerebrate rigidity-A rare case entity

Satish Rudrappa et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: Spinal pseudomeningoceles are extradural collections of cerebrospinal fluid that result following a breach in the dural-arachnoid layer and is reported as one of the complications of lumbar disc surgery. Although they are often self subsiding and asymptomatic, they may occasionally cause low-back pain, headaches, and even nerve root entrapment. The purpose of this case report is to present an unreported presentation of pseudomeningocele PRESENTATION OF CASE: A 34 year obese male presented one month post lumbar discectomy with symptoms suggestive of raised intra cranial pressure presenting as repetitive decerebrate rigidity and altered sensorium lasting for few minutes when there is pressure on the pseudomeningocele sac and subsiding with change in position of the patient. He underwent surgical repair of the dural tear and was improved symptomatically with no recurrence of symptoms at five years follow up.

Discussion: Radiological investigation helped in ruling out the other causes of decerebrate rigidity and the possible mechanism of development of such symptom in pseudomeningocele is discussed.

Conclusion: To the best of our knowledge, this is the first reported case of pseudomeningooele presenting as decerebrate rigidity. Spinal pseudomeningocele can present in varied ways and earliest detection is the key to avoid such complications.

Keywords: Decerebrate rigidity; Dural tear; Pseudomeningocele; Raised intra cranial pressure.

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Figures

Fig. 1
Fig. 1
T2W image showing L4–L5 prolapsed intervertebral disc.
Fig. 2
Fig. 2
axial section showing the prolapsed disc.
Fig. 3
Fig. 3
T2W axial (prone position) did not show hydrocephalus.
Fig. 4
Fig. 4
T2W sagittal section ruled out chiari malformation.
Fig. 5
Fig. 5
Sagittal section T2W image showing communication of the pseudomeningocele with thecal sac.
Fig. 6
Fig. 6
axial section T2W image showing the communication of the pseudomeningocele along the discectomy tract. (Prone position).
See this image and copyright information in PMC

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