A motorcyclist sustains a high-velocity injury and presents with a flail, anaesthetic upper limb. EMG shows absent motor and sensory action potentials in C5–T1 distribution. MRI shows pseudomeningocele formation at C6–C7 and C8–T1 levels. What does the pseudomeningocele indicate and how does it affect prognosis?

• A Post-ganglionic rupture; good prognosis for spontaneous recovery
• B Pre-ganglionic avulsion from the spinal cord; poor prognosis with no potential for nerve root repair ✓
• C Epidural haematoma compressing the roots; emergency surgical decompression required
• D Dural tear at the foramen; conservative management with cervical collar

Explanation

Pseudomeningocele on MRI or myelography indicates traumatic nerve root avulsion from the spinal cord (pre-ganglionic injury), where the root is torn off the cord and CSF leaks into the nerve sheath gap. Pre-ganglionic avulsions are irreparable because the proximal stump is within the spinal cord and no regenerating axons can cross the avulsion site. Management requires nerve transfer (neurotisation) rather than direct repair. Post-ganglionic ruptures may be amenable to repair or grafting.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.