Dear Editor,A 46-year-old male patient experienced monoplegia of the right upper arm immediately after his temporal head struck the bottom of the sea while he was being buffeted by waves. A physician-staffed emergency helicopter evacuated the patient from the scene and transported him to our department. His medical and family history were unremarkable. On arrival, he had clear consciousness and his vital signs were stable. The physiological findings included the right neck pain, anesthesia of the right shoulder, dysesthesia of the right index and middle fingers, and a manual muscle testing grade of 0 at the right deltoids, biceps, and triceps muscles. Cervical computed tomography (CT) demonstrated a minute amount of gas in the sleeve of the right sixth nerve root [Figure 1]. A magnetic resonance image demonstrated that there were no traumatic lesions of the spinal cord and suggested right fifth and sixth nerve root avulsion [Figure 2]. His neurological signs showed no changes until the 5th day of hospitalization when he was discharged from the hospital. As he was tourist, he was followed at his local hospital.
Figure 1
The cervical computed tomography scan on arrival. The computed tomography scan shows a minute amount of gas in the sleeve of the right sixth nerve root
Figure 2
The cervical nerve root on the short tau inversion recovery of magnetic resonance image. The magnetic resonance imaging suggest discontinuity of the right fifth and sixth nerve root (arrow) and partial bony contusion on the 5th and 6th vertebra (triangle)
The cervical computed tomography scan on arrival. The computed tomography scan shows a minute amount of gas in the sleeve of the right sixth nerve rootThe cervical nerve root on the short tau inversion recovery of magnetic resonance image. The magnetic resonance imaging suggest discontinuity of the right fifth and sixth nerve root (arrow) and partial bony contusion on the 5th and 6th vertebra (triangle)This is the first reported case, in which the vascular permeability (VP) was observed in the sleeve of a nerve root. CT is considered to be the imaging modality that most frequently detects the VP in trauma settings because the high spatial resolution allows for the detection of small amounts of gas, and with the improvements of spatial resolution that come year by year, it might be possible to detect minute amounts of gas in the sleeve.[1] The patient's main symptom originated from the cervical fifth and sixth nerve roots; however, CT did not detect the VP in the fifth sleeve. This might be because the complete resection of the sleeve resulted in the leakage of cerebrospinal fluid so that gas might move with the flow of fluid. On CT, gas in the sleeve may suggest nerve root avulsion if a patient does not have an open craniospinal fracture, pneumothorax, gas productive infection, or gas migration due to medical procedures.[23]
Figure 1
Figure 2