title: Cervicothoracic intraspinal pseudomeningocele with cord compression after a traumatic brachial plexus injury.
abstract: BACKGROUND
  Pseudomeningoceles are noted within the neural foramen after avulsion plexus injuries. We present the case of a cervicothoracic epidural pseudomeningocele with spinal cord compression 18 years after a brachial plexus injury.
  
  
  OBJECTIVE
  To present a case report of a patient and literature review on cases with epidural pseudomeningoceles.
  
  
  METHODS
  Case report and review of the literature.
  
  
  METHODS
  Retrospective review of the medical records of a patient presenting with an epidural pseudomeningocele after a plexus injury.
  
  
  RESULTS
  A 37-year-old male presented with neurological decline 18 years after sustaining a brachial plexus injury. Magnetic resonance tomography revealed an epidural fluid collection from C5 to T7 with significant spinal cord compression. Surgical intervention initially involved fenestration of the cyst and then rhizotomies of the C7 and C8 roots resulting in resolution of his new symptoms.
  
  
  CONCLUSIONS
  Pseudomeningoceles are common after brachial plexus avulsion injury and are usually stable, causing no symptoms, other than plexus neuropathies. We are unaware of previous reports of a patient with a traumatic brachial plexus avulsion who developed a large cervicothoracic, symptomatic, spinal, epidural, intracanalicular pseudomeningocele with cord compression 18 years after the initial injury. Patients with prior trauma and known plexus injuries with development of new neurological symptoms should be evaluated for the rare case of intradural pseudomeningoceles. Preoperative imaging with computed tomography myelography is important to isolate and definitively treat the fistulous connection.
authors.affiliation: Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Dan M
authors.initials: DM
authors.lastname: Drzymalski
authors.forename: Jayshree
authors.initials: J
authors.lastname: Tuli
authors.forename: Ning
authors.initials: N
authors.lastname: Lin
authors.forename: Sagun
authors.initials: S
authors.lastname: Tuli
mesh_terms: D000328:Adult; D001917:Brachial Plexus / Q000293:injuries*; D002574:Cervical Vertebrae; D005402:Fistula / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008588:Meningocele / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications; D012086:Reoperation; D019051:Rhizotomy; D013117:Spinal Cord Compression / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D013904:Thoracic Vertebrae