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Table of Contents    
NEUROIMAGES
Year : 2017  |  Volume : 65  |  Issue : 1  |  Page : 226-227

Traumatic retropharyngeal pseudomeningocele following C5-C6 subluxation


Department of Orthopedics and Traumatology, Charles Nicolle's Hospital, Tunis, Tunisia

Date of Web Publication12-Jan-2017

Correspondence Address:
Khaled Hadhri
Department of Orthopedics and Traumatology, Charles Nicolle's Hospital, Boulevard 9 Avril, 1006, Tunis
Tunisia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.198216

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How to cite this article:
Louati A, Hadhri K, Tebourbi A, Kooli M. Traumatic retropharyngeal pseudomeningocele following C5-C6 subluxation. Neurol India 2017;65:226-7

How to cite this URL:
Louati A, Hadhri K, Tebourbi A, Kooli M. Traumatic retropharyngeal pseudomeningocele following C5-C6 subluxation. Neurol India [serial online] 2017 [cited 2017 Feb 23];65:226-7. Available from: http://www.neurologyindia.com/text.asp?2017/65/1/226/198216


A pseudomeningocele results from a tear of the dura leading to the accumulation and extravasation of cerebrospinal fluid (CSF). The usual cause is an unintentional tear of the dura during surgery. The occurrence of a retropharyngeal pseudomeningocele after cervical vertebral dislocation is an extremely rare complication. It usually develops when a traumatic dural tear occurs allowing CSF outflow, and often appears associated with hydrocephalus. A retropharyngeal traumatic pseudomeningocele is considered as a peculiar phenomenon because only seven reports have been described in the literature regarding its intiation following the occurrence of upper cervical spine injuries. To our knowledge, this is the first reported instance of a prevertebral retropharyngeal pseudomeningocele following an uniarticular dislocation of the lower cervical spine. Management of such conditions depends of the prognosis of the patient and the severity of the accompanying pathology.

A 64-year-old man presented to our institution with an isolated cervical injury after falling from a horse. He presented with flaccid quadriplegia corresponding to the C5 level with a spontaneous respiratory effort. Lateral cervical X-ray imaging showed signs of uniarticular C5-C6 subluxation [Figure 1]. Cervical magnetic resonance imaging (MRI) confirmed the presence of complete right facet dislocation and showed a retropharyngeal mass beginning at the C5-C6 interspace and extending ventral and caudal to the C7-T1 interspace [Figure 2] and [Figure 3]. A dural tear in the C5-C6 interspace was found. The spinal cord showed interruption at the C6 level. MRI of the brain revealed no evidence of hydrocephalus. A halo brace was applied and an attempt at reduction was carried out. An anterior cervical fusion was planned; however, the patient developed sudden respiratory failure and several attempts at resuscitation failed to revive him.
Figure 1: Cervical lateral X-ray showing C5-C6 bilateral facet dislocation

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Figure 2: Magnetic resonance imaging axial view demonstrating C5-C6 right facet subluxation with signs for left C5 root avulsion

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Figure 3: Magnetic resonance imaging sagittal reconstruction showing high T2 weighted signal in retropharyngeal space corresponding to cerebrospinal fluid

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Posttraumatic pseudomeningocele is a rare complication of fractures, root avulsions, and vertebral dislocations.[1] The incidence of traumatic pseudomeningocele in the cervical spine is probably very low. It is usually located posteriorly and is often associated with injuries of the brachial plexus or vertebral dislocations. A prevertebral retropharyngeal location is considered to be a peculiar phenomena because only seven reports have been described in the literature, five of them as a sequela of atlantooccipital dislocation [2],[3] and the remaining two derived from atlantoaxial dislocation.[2],[4] To our knowledge, this is the first reported occurrence of a prevertebral retropharyngeal pseudomeningocele following biarticular dislocation of the lower cervical spine.

MRI is considered as the mainstay diagnostic procedure to confirm the presence of a retropharyngeal pseudomeningocele.[1] The pseudomeningocele is characteristically identified as a cystic collection with a signal intensity consistent with CSF in all sequences. Once the diagnosis is confirmed, performing a cranial neuroimaging study is recommended in order to assess the presence of hydrocephalus because these two pathologies often appear associated.[1] In the presented case, probably the C5 root avulsion secondary to the C5-C6 subluxation produced the dural tear, which initiated the collection [Figure 2] and [Figure 3]. The prognosis and the management of such entities are determined by the severity of the initial trauma.[2],[4] In our case, an anterior C5-C6 fusion after ensuring reduction of the dislocation as well as CSF drainage would have been the appropriate procedure to alleviate the condition.

Acknowledgements

The authors wish to thank Professor Mondher Kooli for his teaching and assistance in the preparation of this manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Gutiérrez-Gonzalez R, Boto GR., Pérez-Zamarron A, Rivero-Garvia M. Retropharyngeal pseudomeningocele formation as a traumatic atlanto-occipital dislocation complication: Case report and review. Eur Spine J 2008;17(Suppl 2):S253-6.  Back to cited text no. 1
    
2.
Achawal S, Casey A, Etherington G. Retropharyngeal pseudomeningocele. Br J Neurosurg 2006;20:259-60.  Back to cited text no. 2
    
3.
Cognetti DM, Enochs WS, Willcox TO. Retropharyngeal pseudomeningocele presenting as dysphagia after atlantooccipital dislocation. Laryngoscope 2006;116:1697-9.  Back to cited text no. 3
    
4.
Natale M, Bocchetti A, Scuotto A, Rotondo M, Cioffi FA. Post traumatic retropharyngeal pseudomeningocele. Acta Neurochir 2004;146:735-9.  Back to cited text no. 4
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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