Nerve root avulsion
may result with dural tear forming traumatic pseudo-meningocoele seen as a focal CSF collection extending from the neural foramen (Figure 10).
8) This manner of forceful separation typically results in pre-ganglionic root avulsion or post-ganglionic rupture of the upper roots (C5-C6) while sparing the lower roots (C7, C8, T1).
Pre-ganglionic root avulsion is not amenable to direct repair and nerve transfer remains the best option.
Recent strides have been made in the diagnosis, management, and treatment of upper brachial plexus root avulsion.
Upper root avulsions are devastating injuries because the patient loses the critical functions of shoulder abduction and elbow flexion.
Traction forces on nerves can cause various injuries, ranging from temporary conduction deficits to nerve root avulsion from the spinal cord.
Total plexus injuries require significantly higher traction forces and result in severe injuries with attendant root avulsions and they have a poorer prognosis.
11) The MRI finding of a pseudomeningocele has a low sensitivity (approximately 50%), but a high specificity (approaching 100%) in the diagnosis of nerve root avulsion
The cause of the recurrent SAH is determined on imaging in only 50% of cases (3) and includes dural pathology, postsurgical CSF cavity with neovascularity, bleeding central nervous system (CNS) tumours (ependymoma, oligodendroglioma and astrocytoma), vascular malformations (arteriovenous malformations and cavernous malformation near the brain's surface), aneurysms, and in the spinal cord--tumours, arteriovenous malformations and traumatic nerve root avulsion
19) Regarding permanent BPI not associated with [shoulder dystocia], they noted that "the residual deficit is nearly always mild, whereas nerve root avulsions
and/or complete brachial plexus impairment .