Case Of the Week (COW) 06 December 2015
Traumatic pseudomeningocele
Findings
The sequence is HASTE myelo in coronal and saggittal. Nerve root avulsion with pseudomeningocele involving C6, C7 and C8 nerves on the right side. Features suggestive of post-traumatic preganglionic right brachial plexus injury.
Discussion
Severe traction on the upper limb in for example motor vehicle accident can lead to avulsion of the brachial plexus root sleeves or nerve roots. This is manifested clinically by upper limb weakness and sensory loss. CT myelography, conventional MRI and MR myelography are the methods of choice to detect nerve discontinuity as well as associated findings e.g. Meningocele. While MRI is more powerful to diagnose cord abnormalities e.g. Edema, hemorrhage or myelomalacia and associated muscle atrophy or edema. GRADING OF BRACHIAL PLEXUS INJURIES According to CT myelography, brachial plexus injuries can be classified into SIX types. N Type – normal root sleeve and nerve roots. A1 type – slightly deformed root sleeves and nerve roots as compared to unaffected site. A2 type – obliteration o f the tip of root sleeves and deformed thickened nerve root. A3 type– obliteration of the tip of root sleeves and absent nerve root. D type – root sleeve defect. M type – traumatic meningocele formation.
Contributed By:
Prof. S. Babu Peter, Dr. P. Karthik
Barnard Institute of Radiology
Traumatic pseudomeningocele
Findings
The sequence is HASTE myelo in coronal and saggittal. Nerve root avulsion with pseudomeningocele involving C6, C7 and C8 nerves on the right side. Features suggestive of post-traumatic preganglionic right brachial plexus injury.
Discussion
Severe traction on the upper limb in for example motor vehicle accident can lead to avulsion of the brachial plexus root sleeves or nerve roots. This is manifested clinically by upper limb weakness and sensory loss. CT myelography, conventional MRI and MR myelography are the methods of choice to detect nerve discontinuity as well as associated findings e.g. Meningocele. While MRI is more powerful to diagnose cord abnormalities e.g. Edema, hemorrhage or myelomalacia and associated muscle atrophy or edema. GRADING OF BRACHIAL PLEXUS INJURIES According to CT myelography, brachial plexus injuries can be classified into SIX types. N Type – normal root sleeve and nerve roots. A1 type – slightly deformed root sleeves and nerve roots as compared to unaffected site. A2 type – obliteration o f the tip of root sleeves and deformed thickened nerve root. A3 type– obliteration of the tip of root sleeves and absent nerve root. D type – root sleeve defect. M type – traumatic meningocele formation.
Contributed By:
Prof. S. Babu Peter, Dr. P. Karthik
Barnard Institute of Radiology