hydrocephalus is a well - known complication of brain lesions , but it can also be a rare complication of a spinal lesion . it has been described in association with spinal tumors , spinal infections , and congenital anomalies of the cervicomedullary junction4,5,7,9 ) . however , acute obstructive hydrocephalus caused by cervical fracture and dislocation has been reported extremely rarely . here , we present a rare case of acute obstructive hydrocephalus following a cervical fracture and dislocation . a 60-year - old female patient was referred to our emergency room(er ) with quadriplegia and respiratory difficulty . prompt intubation and mechanical ventilation support were required in the er . on neurological examination , her mental state was alert and cranial nerve functioning was normal , showing no evidence of head injury . however , she showed quadriplegia and anesthesia below the c3 dermatome and her respiration was faint . we also detected decreased anal tone and loss of urinary sense . computed tomography ( ct ) of brain revealed no evidence of abnormalities such as hemorrhage or hydrocephalus ( fig . 1 ) . plain cervical radiography and ct scan of cervical spine revealed a fracture and dislocation at the c3 - 4 level ( fig . 2 ) . cervical spine magnetic resonance imaging ( mri ) with ventilator support demonstrated severe cord compression with evident signal change at the c3 - 4 level ( fig . because of her inability to breathe independently , she was treated conservatively with high - dose methylprednisolone and intravenous fluid . however , 24 hours after the admission , her mental status had deteriorated to stupor , and both her pupils had dilated to 5 mm . 4 ) . to alleviate the symptoms , we performed lumbar cerebrospinal fluid ( csf ) drainage . after the evd , her mental status improved to drowsiness . however , 4 days after evd when the drainage catheter was removed , she fell into a deep stupor and the pupillary reflex disappeared . her family refused further treatment , and she became comatose and expired 2 months after injury because of respiratory failure , in spite of mechanical ventilator support . hydrocephalus is a well - known complication of head injury but an uncommon complication of a spinal lesion . acute hydrocephalus is thought to result from the blockage of csf flow in the brain . specifically , blockage of the ventricular system at the outlet foramen or structural blockage of the arachnoid villi generates a pressure gradient that ultimately leads to the enlargement of the ventricles2 ) . on the contrary , hydrocephalus caused by spine pathologies , such as spinal tumors , spinal infections , postcervical myelography , and congenital abnormalities of the cervicomedullary junction , has been reported . in these cases , the pathology was thought to be caused by the disruption of csf flow , impaired absorption at arachnoid villi due to elevated csf protein or fibrinogen , tumor infiltration into the cistern , direct compression of the ventricular outlet , or compression of the spinal venous plexus by the tumor itself . however , hydrocephalus after spinal trauma is extremely rare . the non - communicating type is usually the result of the obstruction of csf flow due to congenital anomalies such as aqueduct stenosis or tumors . the communicating hydrocephalus is usually post - inflammatory in origin and complicated by acute or chronic meningitis . hydrocephalus that results from head injury is usually communicating8 ) . in our patient , however , we believe that the pathogenesis may be related to non - communicating hydrocephalus . the first possible mechanism is the direct compression of the csf outlet pathways . menendez et al.6 ) reported a case of hydrocephalus with an occipital condylar fracture fragment pushing into the medulla oblongata . this bone fragment may have caused direct compression and obstruction of csf outlets , such as the fourth ventricle , foramen of magendie , or foramen of luschka . the second plausible mechanism of hydrocephalus is a spinal cord edema secondary to complete cord injury . yablon et al.10 ) suggested that the swelling of the spinal cord , observed after spinal trauma , may extend up to two vertebral segments above and below the injured vertebrae . challagundla et al.1 ) reported a case of hydrocephalus following fracture dislocation of c5 - 6 in a patient with ankylosing spondylitis . he postulated that hydrocephalus resulted from the obstruction of csf flow at the fourth ventricular outlets due to the ascending edema of the medulla oblongata from the cervical spine . we conjecture that an edema , ascending the spinal cord to brain stem , may have obstructed the csf flow pathways at the fourth ventricular outlets and raised intracranial pressure in our patient . acute hydrocephalus resulting from complete spinal cord injury following cervical fracture and dislocation is an unusual complication . although rare , it should be considered if the patient 's level of consciousness deteriorates after spinal cord injury .
hydrocephalus is a well - known complication of head injury , but an uncommon complication of a spinal lesion . here 
 , we present a rare case of acute obstructive hydrocephalus secondary to a cervical fracture and dislocation . a 60-year - old female patient was transferred to the emergency department with quadriplegia and respiratory difficulty . 
 imaging studies showed a cervical fracture and dislocation at the c3 - 4 level . 
 she required intubation and mechanical ventilation . 
 twenty - four hours after admission , her mental status had deteriorated and both pupils were dilated . 
 computed tomography of the brain showed acute hydrocephalus ; therefore , extraventricular drainage ( evd ) was performed . after the evd , her mental status recovered and she became alert , but she remained quadriplegic and dependent on the ventilator . 
 two months after injury , she died because of respiratory failure caused by pneumonia .