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Cervical Pseudomeningocele due to Occult Hydrocephalus

Pahys, Joshua M., MD*; Chicorelli, Anne Marie, DO; Asghar, Jahangir, MD; Betz, Randal R., MD; Samdani, Amer F., MD

doi: 10.1097/BRS.0b013e31817343f3
Case Reports
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Study Design. 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).

Summary of Background Data. 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.

Conclusion. 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.

An 8-year-old patient with C2–C3 traumatic quadriplegia presented with changes in mental status after drainage of postsurgical cervical pseudomenigocele 6 weeks after the injury. Delayed onset post-traumatic hydrocephalus was identified and treated with a ventriculo-peritoneal shunt. The patient's clinical status markedly improved.

From the *Albert Einstein Medical Center, Philadelphia, PA; †Philadelphia College of Osteopathic Medicine, Philadelphia, PA; and ‡Shriners Hospitals for Children, Philadelphia, PA.

Acknowledgment date: August 21, 2007. Revision date: November 9, 2007. Acceptance date: January 28, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Dr. Amer F. Samdani, 3551 North Broad Street, Philadelphia, PA 19140; E-mail: amersamdani@yahoo.com

© 2008 Lippincott Williams & Wilkins, Inc.