Traumatic brachial plexus injury with pseudomeningoceles

Case contributed by Mohamed Mahmoud Elthokapy
Diagnosis certain


Right upper limb weakness after a motorcycle accident and direct trauma to the neck 6 weeks ago.

Patient Data

Age: 20 years
Gender: Male

Post-traumatic multiple right brachial plexus (C6 down to D2) pseudo-meningoceles resulting from their related nerve root avulsions.

Acute denervation changes of the right shoulder girdle musculature.

Case Discussion

These findings demonstrate multiple cystic lesions following CSF signal intensity on all sequences are seen along multiple nerve roots on the right side, suggesting the likelihood of post-traumatic pseudomeningocele secondary to nerve root avulsion, denoting multiple direct and indirect signs of pre-ganglionic nerve root injuries.

The presence of pseudomeningocele, usually appears three to four weeks after injury, with non-visualization of the nerve rootlets.

The discontinuity of the rootlet with the abnormal focal cord signal is also a direct sign of an avulsion injury.

The marked muscle edema signal in the right rotator cuff muscles denotes acute denervation changes.

Mild relative thickening and edema signals of the distal brachial plexus divisions could be due to associated neuropraxia or early Wallerian degeneration secondary to proximal root injury.

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