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Rehabilitation Practice and Science

Abstract

An injury to the brachial plexus can lead to the development of a pseudomeningocele, a buildup of cerebrospinal fluid (CSF) in the subarachnoid space caused by tears in the affected root sleeves. External forces acting on the brachial plexus represent the main mechanism of injury. The resulting stretching and tearing of the meninges outside the nerve root led to the pseudomeningocele. Although often initially asymptomatic, a pseudomeningocele can eventually cause pain, paresthesia, muscle weakness, and paralysis. The nerve conduction studies (NCS), electromyography (EMG), and magnetic resonance imaging (MRI) can be used to identify the injury, and treatment can involve either conservative management or surgical intervention if necessary.

Here, we present the case of a 27-year-old male patient who suffered brain damage and multiple fractures in a motorcycle accident. After 2 months of rehabilitation, he began experiencing progressive numbness in his right forearm and hand, and clawing of the fourth and fifth fingers. NCS and EMG revealed the radiculopathy of the eighth cervical and first thoracic nerve roots, and a preganglionic nerve root injury. Cervical MRI showed a pseudomeningocele extending from the seventh cervical to the first thoracic vertebra, accompanied by nerve root avulsion – findings that confirmed the need for surgical intervention.

This case highlights the possibility that symptoms in patients with the brachial plexus and traumatic brain injuries might be overlooked, resulting in opportunities for treatment being missed. This report will hopefully serve as a valuable reference for differential diagnosis and management in such cases.

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