Spinal Cord Herniation Into Associated Pseudomeningocele After Brachial Plexus Avulsion Injury

Yokota, Hiroshi; Yokoyama, Keitaro; Noguchi, Hiroshi; Uchiyama, Yoshitomo

doi:10.1227/01.neu.0000249195.76527.61

Cited by 26 publications

(21 citation statements)

References 32 publications

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“…In patients with traumatic spinal-cord herniation, there was an association with the site of injury. 5 Although most earlier reported patients with traumatic spinal-cord herniation manifested deficits in the ventral or ventrolateral dura mater with tethering of the spinal cord to the dorsal aspect of adjacent vertebrae, dorsolateral spinal-cord herniation was identified in only two, including our patient. Among the 13 patients reported earlier with traumatic spinal cord herniation, only three were associated with nerve root injury; in all, there was an association with brachial plexus injury.…”

Section: Discussioncontrasting

confidence: 51%

“…Traumatic spinalcord herniation is extremely rare; our search of the literature disclosed only 13 cases reported earlier. 1,2,5 Although the etiology of spinal cord herniation remains to be established, in most patients with the idiopathic variation the affected levels range between T4 and T7. In patients with traumatic spinal-cord herniation, there was an association with the site of injury.…”

Section: Discussionmentioning

confidence: 99%

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Traumatic spinal-cord herniation associated with pseudomeningocele after lower-thoracic nerve-root avulsion

et al. 2009

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Background: Traumatic spinal-cord herniation after nerve root avulsion is rare. We report on the first patient with spinal-cord herniation associated with pseudomeningocele in the lower conus medullaris region after nerve avulsion. Case: This 72-year-old man presented with progressive pain in the left leg and motor weakness after two traumatic accidents. Constructive interference in steady-state (CISS) imaging showed the attachment of the spinal cord to the wall of a herniated pseudomeningocele and associated syringomyelia at the level of T12. At the time of surgery, a herniated pseudomeningocele was observed. The lateral portion of the spinal cord that had herniated into the pseudomeningocele was detached from its wall; this was followed by repair of the dural defect. A redundant nerve root was observed inside the pseudomeningocele, suggesting nerve root avulsion as the primary lesion. To facilitate cerebrospinal fluid drainage from the syringomyelia, we next performed dorsal root entry zone (DREZ)tomy to the pseudomeningocele. Postoperatively, he manifested significant clinical improvement. Conclusions: This is the first report of spinal cord herniation after nerve root avulsion in the conus medullaris region. CISS imaging is highly useful for the demonstration of spinal cord herniation, syringomyelia and pseudomeningocele. To restore neurological function in patients with progressive symptoms, we recommend surgical treatment.

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Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Traumatic spinal-cord herniation associated with pseudomeningocele after lower-thoracic nerve-root avulsion

et al. 2009

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“…Since MRI has come into widespread use, the incidence of spinal cord herniation has gradually been accepted [22]. As a result, the number of published reports of this condition has increased and over 30 are documented [1-3, 5-15, 19].…”

Section: Discussionmentioning

confidence: 99%

“…Until now, there have been few reports of a pseudomeningocele developing after a plexus injury [4,16,19]. The incidence of pseudomeningocele after nerve root avulsion was high (21-57%), but until now there is only two reports of a spinal cord herniation developing into this pseudomeningocele [6,22].…”

Section: Discussionmentioning

confidence: 99%

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Spinal cord herniation into pseudomeningocele after traumatic nerve root avulsion: case report and review of the literature

et al. 2007

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We present an extremely rare case of traumatic spinal cord herniation due to a brachial plexus avulsion injury and provide a review of the literature of spinal cord herniation. Spinal cord herniation is an uncommon condition that can occur spontaneously or as a result of surgery or trauma. This condition often presents with symptoms and signs as Brown-Séquard syndrome. Traumatic pseudomeningoceles after a brachial plexus avulsion injury have been reported. But transdural herniation of the spinal cord into this pseudomeningocele is an extremely rare and poorly documented condition. There is only two reports of this condition in a thoracic case. The authors report the case of a 22-year-old man presented with a 2-year history of quadriplegia. He was involved in a motorcycle accident, 3 years prior to his presentation. Four years after the initial right brachial plexus injury, he was not able to walk independently. Magnetic resonance imaging (MRI) and computerized tomography (CT) myelography revealed a lateral pseudomeningocele arising from the right C6-7 and C7-T1 intervetebral foramen and cervical spinal cord herniation into this pseudomeningocele. The patient underwent primary closure of pseudomeningocele to prevent spinal cord reherniation. He can walk with cane and use left arm unrestrictedly at the 2-year follow-up examination. Spinal cord herniation following traumatic nerve root avulsion is extremely rare but it should be considered in the differential diagnosis of patients presenting with delayed myelopathy or Brown-Séquard syndrome.

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Traumatic Plexus Lesion

Dongen

Cohen

Kleef

et al. 2011

Evidence‐Based Interventional Pain Medicine

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Spinal Cord Herniation Into Associated Pseudomeningocele After Brachial Plexus Avulsion Injury

Cited by 26 publications

References 32 publications

Traumatic spinal-cord herniation associated with pseudomeningocele after lower-thoracic nerve-root avulsion

Traumatic spinal-cord herniation associated with pseudomeningocele after lower-thoracic nerve-root avulsion

Spinal cord herniation into pseudomeningocele after traumatic nerve root avulsion: case report and review of the literature

Traumatic Plexus Lesion

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