Disclosures: Adeel Malik, DO: Nothing to disclose

Case Description: Patient presented after motorcycle accident where he was ejected into a ditch. Injuries sustained included a subarachnoid hemorrhage, left radial/ulnar fractures, right ulnar styloid fracture, and lower extremity fractures. Patient underwent multiple orthopedic surgeries including left radius/ulna ORIF. He remained non-weight bearing of upper extremities and he was transferred to acute rehabilitation for further recovery. Upon assessment, he was found to have weakness and numbness of the right hand.

Setting: Tertiary Care Center

Patient: 65-year-old male with past medical history of lumbar disc disease.

Assessment/Results: Electromyography revealed findings consistent with a C8/T1 root level injury. Magnetic resonance imaging of the cervical spine revealed T1 nerve root avulsion injury with cerebrospinal fluid intensity tubular structure, suspicious for pseudomeningocele. Neurosurgery recommendations included aggressive rehabilitation with no surgical intervention. Acute rehabilitation focused on hand strengthening, transfers and ADLs. Patient noted mild improvement in right hand muscle strength but numbness of medial hand and forearm remained.

Discussion: Nerve root avulsion is a severe form of nerve root injury characterized by a complete tear of one or more of the spinal nerve roots. Avulsion injuries may be associated with high energy impact or traction causing stretching of neck and shoulder. Pseudomeningocele formation occurs subsequent to avulsion injury due to an accumulation of CSF in the collaterally damaged meninges surrounding damaged nerve roots. Neurological deficits associated with nerve root avulsion range from partial motor function loss to complete paralysis and may be repaired surgically. MRI, physical exam, and nerve conduction studies are used in conjunction to localize the injury and determine the extent of neurological deficits.

Conclusion: Symptomatic nerve root avulsion with pseudomeningocele formation is often a debilitating injury. Prognosis for a significant recovery in function remains poor. Acute rehabilitation as well as newly evolving surgical procedures such as nerve grafts, nerve transfers or muscle transfers offer hope.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/t1-nerve-root-avulsion-injury-with-pseudomeningocele-formation-following-motorcycle-accident-a-case-report/