Figure 4 - uploaded by Montserrat Lara-Velazquez
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(A) Head CT scan taken two weeks prior to the second pseudo-meningocele repair surgery shows normal size of the ventricles. (B) CT scan taken after the second pseudo-meningocele repair surgery shows marked dilatation of the lateral and third ventricles including the temporal horns, consistent with communicating hydrocephalus. (C) CT scan taken after placement of a right ventriculo-peritoneal shunt demonstrates normal sized ventricles.
Source publication
Introduction: We report a case of a 49-year-old man who sustained a left brachial plexus injury and traumatic brain injury after a motor vehicle accident and subsequently developed a giant left cervical pseudomeningocele. The patient suffered multiple fractures in the cervical and thoracic ribs, transverse processes and the scapula. Physical examin...
Contexts in source publication
Context 1
... to an acute decline in his mental status, CT of the head was done immediately, and was compared to the scan taken two weeks prior ( Figure 4A). The new scan revealed acute communicating hydrocephalus, with moderate enlargement of the lateral and third ventricles without evidence of intracranial haemorrhage or mass ( Figure 4B). ...
Context 2
... to an acute decline in his mental status, CT of the head was done immediately, and was compared to the scan taken two weeks prior ( Figure 4A). The new scan revealed acute communicating hydrocephalus, with moderate enlargement of the lateral and third ventricles without evidence of intracranial haemorrhage or mass ( Figure 4B). This finding prompted the patient to undergo an emergent right ventriculoperitoneal shunt placement ( Figure 4C). ...
Context 3
... new scan revealed acute communicating hydrocephalus, with moderate enlargement of the lateral and third ventricles without evidence of intracranial haemorrhage or mass ( Figure 4B). This finding prompted the patient to undergo an emergent right ventriculoperitoneal shunt placement ( Figure 4C). ...
Citations
Introduction:
Formation of meningocele in brachial plexus injury is known and can be diagnosed on magnetic resonance imaging (MRI). It is mainly reported in brachial plexus root avulsion injuries and does not require specific treatment. We report accurate diagnosis and management of dreadful complication due to rupture of meningocele post-brachial plexus exploration.
Case report:
A 23-year-old engineer presented at 4 months post-bike accident right side extended brachial plexus injury involving C5, C6, and C7. On MRI, he had meningocele in C6-7 root region. We performed supraclavicular exploration of brachial plexus and distal nerve transfers for shoulder abduction and elbow flexion. During surgery, the meningocele was ruptured. As the cyst was deep and extending toward apex of lung, the diagnosis of fluid drained had to be distinguished from pleural fluid with cerebrospinal fluid (CSF). We found hemo-glucose test and beta-2-transferrin levels are mandatory to confirm the diagnosis. Post-surgery, the patient had drainage of almost 500 cc of CSF from wound every day for 3 days. This was managed by repeat MRI and finally lumbar puncture drainage helped to seal the meningocele in neck.
Conclusion:
Meningocele in brachial plexus injury is common but rupture of cyst can be fatal. To confirm the origin of fluid, beta-2-transferin level is more specific test than the hemo-glucose test. Lumbar puncture and drainage away from neck can be more reliable modality of treatment in case of intraoperative rupture of such cysts if drainage is excessive postoperatively.
