J Korean Neurosurg Soc.  2013 Aug;54(2):145-147. 10.3340/jkns.2013.54.2.145.

Acute Hydrocephalus Following Cervical Spinal Cord Injury

• Son S
• Lee SG
• Park CW
• Kim WK

• KMID: 1814255
• DOI: http://doi.org/10.3340/jkns.2013.54.2.145

Abstract

We present a case of acute hydrocephalus secondary to cervical spinal cord injury in a patient with diffuse ossification of the posterior longitudinal ligament (OPLL). A 75-year-old male patient visited the emergency department with tetraparesis and spinal shock. Imaging studies showed cervical spinal cord injury with hemorrhage and diffuse OPLL from C1 to C4. We performed decompressive laminectomy and occipitocervical fusion. Two days after surgery, his mental status had deteriorated to drowsiness with dilatation of the right pupil. Findings on brain computed tomography revealed acute hydrocephalus and subarachnoid hemorrhage in the cerebellomedullary cistern, therefore, extraventricular drainage was performed immediately. Acute hydrocephalus as a complication of cervical spine trauma is rare, however, it should be considered if the patient shows deterioration of neurologic symptoms.

Keyword

Hydrocephalus; Spinal cord injuries; Ossification of the posterior longitudinal ligament of the spine

MeSH Terms

Aged
Brain
Dilatation
Drainage
Emergencies
Hemorrhage
Humans
Hydrocephalus
Laminectomy
Longitudinal Ligaments
Male
Neurologic Manifestations
Ossification of Posterior Longitudinal Ligament
Pupil
Shock
Sleep Stages
Spinal Cord
Spinal Cord Injuries
Spine
Subarachnoid Hemorrhage

Figure

• 

  Fig. 1 Preoperative cervical MRI. A : Sagittal cervical MRI revealing thick diffuse OPLL with cord compression and heterogeneous signal change from the cervicomedullary junction to the C4 level. B : Also, axial MRI reveals right side dominant spinal cord compression and signal change of the spinal cord. MRI : magnetic resonance imaging, OPLL : ossification of the posterior longitudinal ligament.

• 

  Fig. 2 Decompressive total laminectomy from C1 to C5, and occipitocervical fusion were performed.

• 

  Fig. 3 Brain CT shows marked enlargement of the lateral, third, and fourth ventricles. Also, SAH is observed in the cerebellomedullary cistern (arrows). CT : computed tomography, SAH : subarachnoid hemorrhage.

Reference

1. Challagundla SR, Joseph G, Brown J, McLean AN, Fraser MH. Hydrocephalus complicating a cervical spine fracture in a patient with ankylosing spondylitis. Br J Neurosurg. 2008; 22:700–701. PMID: 18661317.

2. Haddad FS, Haddad GF, Taha J. Traumatic intracranial aneurysms caused by missiles : their presentation and management. Neurosurgery. 1991; 28:1–7. PMID: 1994264.

3. Hossain M, Brown J, McLean AN, Fraser MH. Delayed presentation of post-traumatic aneurysm of the posterior inferior cerebellar artery in a patient with spinal cord injury. Spinal Cord. 2002; 40:307–309. PMID: 12037714.

4. Joseph G, Johnston RA, Fraser MH, McLean AN. Delayed hydrocephalus as an unusual complication of a stab injury to the spine. Spinal Cord. 2005; 43:56–58. PMID: 15303114.

5. Kim YD, Kim DH. Lumbar schwannoma associated with hydrocephalus. J Korean Neurosurg Soc. 2005; 37:228–231.

6. Menéndez JA, Başkaya MK, Day MA, Nanda A. Type III occipital condylar fracture presenting with hydrocephalus, vertebral artery injury and vasospasm : case report. Neuroradiology. 2001; 43:246–248. PMID: 11305760.

7. Mirone G, Cinalli G, Spennato P, Ruggiero C, Aliberti F. Hydrocephalus and spinal cord tumors : a review. Childs Nerv Syst. 2011; 27:1741–1749. PMID: 21928038.

8. Saboe LA, Reid DC, Davis LA, Warren SA, Grace MG. Spine trauma and associated injuries. J Trauma. 1991; 31:43–48. PMID: 1986132.

9. Schuster JM, Santiago P, Elliott JP, Grady MS, Newell DW, Winn HR. Acute traumatic posteroinferior cerebellar artery aneurysms : report of three cases. Neurosurgery. 1999; 45:1465–1467. discussion 1467-1468. PMID: 10598715.

10. Sudo H, Taneichi H, Kaneda K. Secondary medulla oblongata involvement following middle cervical spinal cord injury associated with latent traumatic instability in a patient with ossification of the posterior longitudinal ligament. Spinal Cord. 2006; 44:126–129. PMID: 16010272.

11. Yablon IG, Ordia J, Mortara R, Reed J, Spatz E. Acute ascending myelopathy of the spine. Spine (Phila Pa 1976). 1989; 14:1084–1089. PMID: 2588057.