The role of MR Myelogram in diagnosing traumatic pseudomeningocele

Yıl 2013, Cilt: 18 Sayı: 3, 113 - 117, 02.10.2013

Hanifi Bayaroğulları Nesrin Atci , Murat Altaş , Mustafa Aras , Raif Özden

Öz

Background: Traumatic pseudomeningocele is a valuable indicator of nerve root injury. Secondary to trauma, the traction forces firstly tear meninges and later if the traction forces are great enough, nerve root avulsions occur. In this article we aimed to show pseudomeningoceles localized at the level of brachial and lumbar plexus secondary to nerve root injury.

Methods: We retrospectively reviewed the patients who admitted to our hospital between 2009 and 2011 due to various accidents. After clinical and radiological examinations, spinal root injuries were detected in six patients at different levels.

Result: Brachial plexopathy was detected in four patients and lumbosacral plexopathy was detected in two patients.

Conclusion: Pseudomeningocele is a valuable indicator of nerve root injury. It occurs after dural torn like pouch. MR and MR myelography is the best imaging modality to indicate its’ pouch and cerebrospinal fluid (CSF) within it. MR and MR myelography are best effective imaging modalities to indicate the pseudomeningoceles due to nerve root injury.

 

Key words: brachial plexopathy, lomber plexopathy, magnetic resonance myelography, pseudomeningocele

 

Anahtar Kelimeler

Brachial plexopathy, lomber plexopathy, magnetic resonance myelography, pseudomeningocele

Kaynakça

• Walter LO, Donald WC, Isabelle B, Jacques R. Spine and spinal cord trauma. In: Manelfe C, ed. Imaging of the Spine and Spinal Cord. New York: Raven Press, 1992, pp 407-444.
• Dubendorf P Spinal cord injury pathophysiology. Crit Care Nurs Q 1999; 22:31-35.
• Delmas PF, Roger B, Travers V, Laval-Jeantet M, Sedel L. Modern technics for studying injuries of the lumbo-ischiatic plexus. Apropos of a new case J Radiol 1986; 67:115-118.
• Finney LA, WulfmanWA. Traumatic intradural lumbar nerve root avulsion with associated traction injury to the common peroneal nerve. Am J Roentgenol 1960; 84:952-957.
• Goodell CL. Neurological deficits associated with pelvic fractures. J. Neurosurg1966; 24:837-842.
• DaSilva VR, Al-Gahtany M, Midha R, Sarma D, Cooper P. Upper thoracic spinal cord herniation after traumatic nerve root avulsion. J Neurosurg: Spine 2003; 99:306–309.
• Yokota H, Yokoyama K, Noguchi H, Uchiyama Y. Spinal cord herniation into associated pseudomeningocele after brachial plexus avulsion injury: case report. Neurosurgery 2007; 60:E205.
• Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951; 74:491–516.
• Nagano A Treatment of brachial plexus injury. J Orthop Sci 1998; 3:71–80.
• Millesi H Brachial plexus injuries. In: Jupiter JB, ed. Flynn’s hand surgery. 4th ed. Baltimore, Md: Williams & Wilkins, 1991, pp 457–463.
• Gutowski KA, Orenstein HH. Restoration of elbow flexion after brachial plexus injury: the role of nerve and muscle transfers. Plast Reconstr Surg 2000; 106:1348–1357.
• Terzis JK, Vekris MD, Soucacos PN. Outcomes of brachial plexus reconstruction in 204 patients with devastating paralysis. Plast Reconstr Surg 1999; 104:1221–1240.
• Gupta RK, Mehta VS, Banerji AK, Jain RK. MR evaluation of brachial plexus injuries. Neuroradiology 1989; 31:377-381.
• Maillard JC, Zouaoui A, Bencherif B, Bouayed N, Chedid G, Marsault C. Imaging in the exploration of lumbosacral plexus avulsion. J Neuroradiol 1992; 19:38–48.
• Hans FJ, Reinges MH, Krings T. Lumbar nerve root avulsion following trauma: balanced fast field-echo MRI. Neuroradiology 2004; 46:144–147.
• Rankine JJ. Adult traumatic brachial plexus injury. Clin Radiol 2004; 59:767–774.
• Sachdev VP, Huang YP, Shah CP, Malis LI. Posttraumatic pseudomeningocele (enlarging fracture ?) in a vertebral body. J Neurosurg 1981; 54:545-549.
• Petras AF, Sobel DF, Mani JR, Lucas PR. CTmyelography in cervical nerve root avulsion. J Comput Assist Tomogr 1985; 9:275-279.
• Figueroa RE, Stone JA. MR imaging of degenerative spine disease: MR myelography and imaging of the posterior spinal elements. In: Castillo M., ed. Spinal imaging, state of art. Philadelphia: Hanley & Belfus, 2001, pp 105-122.
• Bowen BC, Seidenwurm DJ. For the Expert Panel on Neurologic Imaging. Plexopathy AJNR Am J Neuroradiol 2008; 29:400-402.
• Smith AB, Gupta N, Strober J, Chin C. Magnetic resonance neurography in children with birthrelated brachial plexus injury. Pediatr Radiol 2008; 38:159–163.