Profound Finger Extension Weakness 21 Years After a Traumatic Lumbar Spine Pseudomeningocele

We present a case report of traumatic pseudomeningocele and a review of the literature and discussion of the neuro-cytoarchitecture to address the disproportionate weakness of extensor neurons seen in the case. A 42-year old man developed profound hand weakness 21 years after a lumbar spinal fracture. An examination revealed bilateral hand weakness affecting the extensors of the hands. Imaging studies revealed an extensive ventral epidural pseudomeningocele extending from the area of the lumbar spinal fracture to the cervical spine posteriorly displacing the spinal cord and the ventral motor roots. The patient was successfully treated with a subarachnoid–peritoneal shunt, which completely resolved the epidural pseudomeningocele and resulted in improvement but not resolution of his neurologic deficits. •A patient developed a traumatic pseudomeningocele resulting in symptoms 21 years after the initial injury.•Cerebrospinal fluid dynamics is an important consideration in management of pseudomeningoceles.•Subarachnoid–peritoneal shunt placement is an effective and viable method of pseudomeningocele management.