Cervical pseudomeningocele due to occult hydrocephalus.
METHODS
Case report with a brief review of the literature.


OBJECTIVE
To describe a rare clinical presentation of post-traumatic hydrocephalus (PTH) in a child who sustained a complete cervical spinal cord injury (SCI).


BACKGROUND
The incidence of PTH can be as high as 30% in cases of pediatric SCI and traumatic brain injury. Presentation may include gait disturbance, altered mental status, or incontinence. To our knowledge, this is the first documentation of PTH presenting as a postsurgical pseudomeningocele.


METHODS
An 8-year-old girl involved in a motor vehicle accident sustained a C2-C3 fracture dislocation resulting in a complete SCI. She was initially treated with C2-C3 sublaminar wiring and halo placement. At postoperative week 6, the patient underwent drainage of a posterior cervical pseudomeningocele and repair of a small dural leak at C2-C3. She subsequently exhibited signs of altered mental status, and computed tomography scan revealed a significant hydrocephalus.


RESULTS
Emergent ventriculostomy was performed, and was converted to a ventriculo-peritoneal shunt 2 days later. The patient's neurologic status markedly improved, and she continues to do well at 2 months after surgery.


CONCLUSIONS
PTH presenting as a pseudomeningocele is extremely rare. In a patient with polytrauma and concomitant traumatic brain injury, the spine surgeon should consider hydrocephalus as a potential cause for a postsurgical pseudomeningocele, even several months after initial injury.
Pahys
Joshua M
JM
Albert Einstein Medical Center, Philadelphia, PA, USA.
Chicorelli
Anne Marie
AM
Asghar
Jahangir
J
Betz
Randal R
RR
Samdani
Amer F
AF
D000063:Accidents, Traffic; D001930:Brain Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D004204:Joint Dislocations / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008588:Meningocele / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013119:Spinal Cord Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D016103:Spinal Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt; D014696:Ventriculostomy