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Case Reports
. 2023 Jan 31;33(2):264-266.
doi: 10.1055/s-0042-1760283. eCollection 2023 Apr.

Spinal Cord Herniation into a Pseudomeningocele-A Delayed Presentation following a Traumatic Cervical Root Avulsion Injury

Jay Patel  1 , James Stewart  2 , Shubhabrata Biswas  1 , Sarsam Zaid  2
Affiliations
Case Reports

Spinal Cord Herniation into a Pseudomeningocele-A Delayed Presentation following a Traumatic Cervical Root Avulsion Injury

Jay Patel et al. Indian J Radiol Imaging. .

Abstract

Background Spinal cord herniation into a traumatic pseudomeningocele is a rare clinical entity. We present the sixth known case and describe surgical management. Case Presentation A 44-year-old male presented with Brown-Sequard syndrome three decades after a cervical nerve root avulsion injury. Imaging revealed hemicord herniation into a C7/T1 pseudomeningocele in addition to extra-axial cord compression from further pseudomeningoceles. Significant clinical improvement was achieved following surgical repair. The radiological findings and technique for operative repair are described. Conclusion The case highlights this rare pathology and presentation, describes the surgical measures for repair of cord herniation, and provides evidence for the favorable outcome that can be achieved by surgical intervention.

Keywords: herniation; pseudomeningocele; spinal cord; trauma.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Preoperative images. ( A ) Sagittal T1- and T2-weighted images demonstrate multiple pseudomeningoceles (white arrows) through left-sided cervical and upper thoracic nerve root foramina. ( B ) Axial T2-weighted image shows herniation of the left side of the spinal cord (black arrow) through dura (white arrow) approximately at the level of the C7 vertebra. There is mild increased signal through the herniated portion of the cord due to edema. ( C ) Axial T2-weighted image shows intraspinal extradural pseudomeningocoele causing displacement of the spinal cord to the right, caudal to the level of cord herniation.
Fig. 2
Fig. 2
Postoperative images at 6 months. ( A ) Sagittal T2-weighted images show marked regression of the pseudomeningocoele at the level of surgery. ( B ) Axial T2-weighted image shows intradural position of the cord. There is a linear high signal intensity in the left hemicord at this level which at 6 months is likely due to gliosis especially in the context of associated volume loss. ( C ) Axial T2-weighted imaging caudal to the level of cord herniation. The cord remained in a slightly eccentric position on subsequent imaging without evidence of adhesion.
See this image and copyright information in PMC

References

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