Tardy spinal cord tumor following avulsive brachial plexus injury: coincidental or causal?

Abstract

Late neurologic deterioration after brachial plexus injury (BPI) is uncommon and may be caused by multiple etiologies. An unusual, previously unreported, case of late neurologic deterioration after BPI is presented. A pediatric patient previously treated for a traumatic preganglionic BPI and presenting with neurologic deterioration 5 years after his injury is reviewed. Magnetic resonance imaging and computed tomography myelogram revealed spinal cord herniation at the same level of the previous nerve root avulsions. Surgical open biopsy demonstrated a spinal cord anaplastic astrocytoma. Despite craniospinal radiotherapy and different regimens of chemotherapy, he died 4 years later from leptomeningeal spread. This case illustrates a previously unreported cause of late neurologic deterioration following BPI. The probable coincidental versus possible causal interrelationship of these two processes (BPI and spinal cord tumor) is discussed, but no conclusions can be reached.