Cervical pseudomeningocele due to occult hydrocephalus

Study Design. Case report with a brief review of the literature. Objective. To describe a rare clinical presentation of post-traumatic hydrocephalus (PTH) in a child who sustained a complete cervical spinal cord injury (SCI). Summary of Background Data. The incidence of PTH can be as high as 30% in cases of pediatric SCI and traumatic brain injury. Presentation may include gait disturbance, altered mental status, or incontinence. To our knowledge, this is the first documentation of PTH presenting as a postsurgical pseudomeningocele. Methods. An 8-year-old girl involved in a motor vehicle accident sustained a C2-C3 fracture dislocation resulting in a complete SCI. She was initially treated with C2-C3 sublaminar wiring and halo placement. At postoperative week 6, the patient underwent drainage of a posterior cervical pseudomeningocele and repair of a small dural leak at C2-C3. She subsequently exhibited signs of altered mental status, and computed tomography scan revealed a significant hydrocephalus. Results. Emergent ventriculostomy was performed, and was converted to a ventriculo-peritoneal shunt 2 days later. The patient's neurologic status markedly improved, and she continues to do well at 2 months after surgery. Conclusion. PTH presenting as a pseudomeningocele is extremely rare. In a patient with polytrauma and concomitant traumatic brain injury, the spine surgeon should consider hydrocephalus as a potential cause for a postsurgical pseudomeningocele, even several months after initial injury.