title: Traumatic Cervical Nerve Root Avulsion with Pseudomeningocele Formation.
abstract: Cervical nerve root avulsion is a well-documented result of motor vehicle collision (MVC), especially when occurring at high velocities. These avulsions are commonly traction injuries of nerve roots that may be accompanied by a tear in the meninges through the vertebral foramina with associated collections of cerebrospinal fluid (CSF), thereby resulting in a pseudomeningocele. We present a case of a 19-year-old male who experienced an MVC and was brought to the emergency department (ED) with right arm paralysis and other injuries. A neurological examination demonstrated intact sensation but 0/5 muscle strength in the right upper extremity. A magnetic resonance imaging (MRI) of the spinal cord demonstrated massive epidural hematomas extending the length of the cervical spine caudally from C2. An MRI of the right brachial plexus showed C3-C7 anterior horn cell edema and associated traumatic nerve root avulsion with pseudomeningoceles on the right from C5-C8. The development of spinal cord hematoma with these injuries has rarely been documented in the literature and the multiple level avulsion described here with extensive hematoma is a rare clinical presentation. A literature review was conducted to determine the diagnostic requirements, treatment strategies, and complications of such an injury. Our patient received conservative treatment of the right brachial plexus injury and was transferred to an inpatient rehabilitation facility 13 days later.
authors.affiliation: Texas A&M College of Medicine.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Haider
authors.affiliation: Texas A&M College of Medicine.
authors.forename: Ian T
authors.initials: IT
authors.lastname: Watson
authors.affiliation: Texas A&M College of Medicine.
authors.forename: Suraj
authors.initials: S
authors.lastname: Sulhan
authors.affiliation: Texas A&M College of Medicine.
authors.forename: Dean
authors.initials: D
authors.lastname: Leonard
authors.affiliation: UT Houston Medical School, Memorial Hermann.
authors.forename: Eliel N
authors.initials: EN
authors.lastname: Arrey
authors.affiliation: School of Medicine, St. Georges University.
authors.forename: Umair
authors.initials: U
authors.lastname: Khan
authors.affiliation: Texas A&M College of Medicine.
authors.forename: Phu
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: Department of Radiology, Baylor University Medical Center.
authors.forename: Kennith F
authors.initials: KF
authors.lastname: Layton
keywords: cervical nerve root avulsion; epidural hematoma; pseudomeningocele