Disclosures: Lea Jarrett: No financial relationships or conflicts of interest

Case Diagnosis: A 70-year-old female with intracranial hypotension secondary to cervical pseudomeningocele.

Case Description or Program Description: The patient underwent C6-C7 laminectomy for resection of a meningioma. The dura was torn and packed with bovine allograft pericardium with no concern for cerebrospinal fluid leakage. On post-operative day (POD) 5, the patient was transferred to an inpatient rehabilitation (IPR) facility. IPR stay was complicated by fatigue, nausea, and cognitive impairment. On POD 14, magnetic resonance imaging (MRI) was concerning for pseudomeningocele measuring 3.5 cm x 3.0 cm x 5.5 cm. Neurosurgery recommended observation. She continued to have nausea and cognitive impairment. On POD 35, repeat MRI demonstrated enlarging pseudomeningocele at 8.3 cm x 7.2 cm x 6.5 cm. A behavioral psychologist diagnosed moderate-to-severe neurocognitive disorder. The patient also reported intermittent headaches, vertigo, and enlargement of cervical swelling. The treating physiatrist suspected intracranial hypotension secondary to pseudomeningocele. Neurosurgery continued to recommend observation. On POD 42, the patient underwent operative repair of the pseudomeningocele and placement of a fat graft.

Setting: A major academic hospital and an inpatient rehabilitation facility.

Assessment/Results: After repair, the patient experienced return to cognitive baseline and was readmitted to IPR. At follow-up visits, she remained asymptomatic and continued to progress functionally.

Discussion (relevance): Pseudomeningocele is a rare complication in less than 2% of spinal surgeries. Patients may be asymptomatic or present clinically with altered mental status, pain, postural headaches, nausea, and emesis. Management options include clinical observation, bed rest, epidural blood patch application, or surgical repair. To our knowledge, there are few cases with significant cognitive impairment associated with pseudomeningocele reported in the literature.

Conclusions: Pseudomeningocele with intracranial hypotension should be considered a cause of persistent confusion after a dural tear. Awareness of this rare complication may aid in early diagnosis and resolution of cognitive decline and reduce length of hospital stay in these patients.

Level of Evidence: Level IV

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/impaired-cognition-in-cervical-pseudomeningocele-a-case-report/