lunedì 20 ottobre 2008

Multiple post traumatic pseudomeningoceles secondary to brachial plexus avulsion with atrophy and myelomalacia of the spinal cord







Findings

Right-sided cyst-like structures are demonstrated at C7-T3. At T1-T2 and T2-T3 these coalesce to form a larger cystic structure overlying the right lung apex.
Additional history: Young adult with history of traumatic brachial plexus injury 2 years ago, now with new onset weakness.

These findings are compatible with the patient's history of previous traumatic right brachial plexus nerve root injury. Since the prior examination, these "pseudomeningoceles" have significantly increased in size. There is a focal 1.5 cm atrophy of the spinal cord with a 6 mm in length area of increased T2 signal is demonstrated within the spinal cord at T1-T2 level consistent with myelomalacia likely the result of the patient's previous nerve root injury.


Diagnosis: Multiple post traumatic pseudomeningoceles secondary to brachial plexus avulsion with atrophy and myelomalacia of the spinal cord


Key points

Cervical nerve root avulsions are the result of traction injuries of the upper extremities that tear the roots from the spinal cord. The roots are absent on the ipsilateral side and the spinal cord is pulled towards the contralateral side.
Pseudomeningoceles are associated with this type of injury. They result from tears in the arachnoid or dura and can easily be identified by MR or CT myelography.
They can be asymptomatic, or present in an acute or delayed fashion with symptoms of myelopathy.
A very rare complication is development of spinal cord herniation.

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