Right C8 nerve root avulsion with psuedomeningocele

History: 45-year-old man with phantom pain after traumatic right arm amputation

LINK (not exact case)

Image result for Right C8 nerve root avulsion with pseudomeningocele

Findings: An oblique view from a cervical myelogram demonstrates no normal exiting nerve roots and an abnormal collection of contrast on the right at C7/T1 (I don’t have the original images). Axial postmyelogram CT and coronal reformatted images better show the right-sided C7/T1 contrast collection.

Diagnosis: Right C8 nerve root avulsion with psuedomeningocele

Discussion: Nerve root avulsions occur secondary to severe traction on the exiting nerve roots. These are seen most commonly in the cervical spine in association with traction injuries of the arm but can occurs in the lumbosacral region secondary to lumbosacral or pelvic fractures.

In medicine, an avulsion is an injury in which a body structure is forcibly detached from its normal point of insertion by either trauma or surgery (from the Latin avellere, meaning “to tear off”).

The typical appearance on myelography, CT myelography, or MRI is that of an absent exiting nerve root at the level of the neural foramen. The avulsed nerve root often reacts laterally, leaving a cerebrospinal fluid filled cavity or pseudomeningocele in the lateral aspect of the spinal canal extending into the neural foramen and occasionally extra-foraminally into the surrounding paraspinous soft tissues. Although psudomeningoceles typically fill with contrast introduced into the subarachnoid space, they can occasionally become walled off and present as extradural cystic masses. Although many nerve root avulsions occur in association with motor vehicle accidents they also occur during birth from excessive traction on the shoulder.

A pseudomeningocele is an abnormal collection of cerebrospinal fluid (CSF) that communicates with the CSF space around the brain or spinal cord.

Aunt Minnie’s Pearls

  • Sever traction injuries of the arm can lead to nerve root avulsion and pseudomeningocele formation.

Image result for neural foramen

foramen
an opening, hole, or passage, especially in a bone.

2 thoughts on “Right C8 nerve root avulsion with psuedomeningocele

  1. Can I send an image to an email address. I was forcibly pushed side ways unexpectantly. I was thrown two metres coming down on my straightened arm. I already had fractures of the right side after being hit by a car and many whiplash. Another whiplash I sustained after this injury. One year later I was cleaning up high with pressure. I felt pain so I stopped. The next day I had severe pain, burning in the corner of my neck. Lasting for 8 mths. It is stil. Painful a year later. I have little use of my arm hand and fingers. I cannot straighten my ring finger since Moments after the fall and it feels broken to move it.
    I would like to know if its torn for sure. I have an appointment for the hospital now. Can you give me an opinion. Please.

    Like

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