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  • Title: Cervical pseudomeningocele due to occult hydrocephalus.
    Author: Pahys JM, Chicorelli AM, Asghar J, Betz RR, Samdani AF.
    Journal: Spine (Phila Pa 1976); 2008 May 20; 33(12):E394-6. PubMed ID: 18496335.
    Abstract:
    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.
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