Retropharyngeal pseudomeningocele formation as a traumatic atlanto-occipital dislocation complication: case report and review

• Published in: European spine journal Vol. 17; no. Suppl 2; pp. 253 - 256
• Main Authors: Gutiérrez-González, Raquel, Boto, Gregorio R., Pérez-Zamarrón, Álvaro, Rivero-Garvía, Mónica
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.09.2008; Springer Nature B.V
• Subjects: Accidents, Traffic; Adult; Atlanto-Occipital Joint - diagnostic imaging; Atlanto-Occipital Joint - injuries; Atlanto-Occipital Joint - pathology; Brain Injuries - complications; Case Report; Cervical Atlas - diagnostic imaging; Cervical Atlas - injuries; Cervical Atlas - pathology; Fatal Outcome; Female; Glasgow Coma Scale; Humans; Joint Dislocations - complications; Joint Dislocations - diagnostic imaging; Joint Dislocations - pathology; Medicine; Medicine & Public Health; Meningocele - etiology; Meningocele - pathology; Meningocele - physiopathology; Neurosurgery; Occipital Bone - diagnostic imaging; Occipital Bone - injuries; Occipital Bone - pathology; Persistent Vegetative State - diagnostic imaging; Persistent Vegetative State - etiology; Persistent Vegetative State - pathology; Pharynx - diagnostic imaging; Pharynx - injuries; Pharynx - pathology; Prognosis; Quadriplegia - etiology; Radiography; Respiration, Artificial; Respiratory Insufficiency - etiology; Spinal Cord Injuries - complications; Spinal Injuries - complications; Spinal Injuries - pathology; Spinal Injuries - physiopathology; Subarachnoid Hemorrhage, Traumatic - complications; Subdural Effusion - diagnostic imaging; Subdural Effusion - etiology; Subdural Effusion - pathology; Surgical Orthopedics; Withholding Treatment; Retropharyngeal; Atlanto-occipital dislocation; Spinal cord injury; Pseudomeningocele
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-007-0531-7

Retropharyngeal pseudomeningocele after atlanto-occipital dislocation is a rare complication, with only five cases described in the literature. It develops when a traumatic dural tear occurs allowing cerebrospinal fluid outflow, and it often appears associated with hydrocephalus. We present a case of a 29-year-old female who suffered a motor vehicle accident causing severe brain trauma and spinal cord injury. At hospital arrival the patient scored three points in the Glasgow Coma Scale. Admission computed tomography of the head and neck demonstrated subarachnoid hemorrhage and atlanto-occipital dislocation. Three weeks later, when impossibility to disconnect her from mechanical ventilation was noticed, a magnetic resonance imaging of the neck showed a large retropharyngeal pseudomeningocele. No radiological evidence of hydrocephalus was documented. Given the poor neurological status of the patient, with spastic quadriplegia and disability to breathe spontaneously due to bulbar-medullar injury, no invasive measure was performed to treat the pseudomeningocele. Retropharyngeal pseudomeningocele after atlanto-occipital dislocation should be managed by means of radiological brain study in order to assess for the presence of hydrocephalus, since these two pathologies often appear associated. If allowed by neurological condition of the patient, shunting procedures such as ventriculo-peritoneal or lumbo-peritoneal shunt placement may be helpful for the treatment of the pseudomeningocele, regardless of craniocervical junction management.