Introduction Pseudo-meningocele is an abnormal collection of cerebrospinal fluid in the extradural space that occurs due to leakage from the CSF-filled spaces surrounding the brain and spinal cord. Pseudo-meningocele may result after spinal surgery. We report a case of a young woman with pseudo-meningocele post lumbar spinal surgery. She subsequently developed recurrent syncope, headaches and clinical signs of raised intracranial pressure (severe papilledema and retinal haemorrhages).

Case A 34 year old woman with spina bifida occulta and a large lipoma at the lumbar spinal level of L5 presented with urinary retention, worsening right leg pain, numbness and foot drop. She subsequently underwent L4-S1 laminectomy, debulking of lipoma and detethering of the cord. Her neurological deficits resolved post-surgery. One month later, the patient re-presented with recurrent syncope and intermittent headaches. She was admitted to the hospital for further investigations. Detailed neurological examination revealed grade IV papilledema and retinal haemorrhages. MRI of the brain showed distended optic nerve sheaths and narrowed distal transverse sinuses, in keeping with intracranial hypertension. MRI spine showed a large CSF collection posterior to the spinal canal at the L4-L5 level, measuring 77×53 mm in trans axial plane and 98 mm in craniocaudal dimension. Her symptoms improved with insertion of external ventricular drain. The symptoms resolved completely after a ventriculo-peritoneal shunt was inserted. She was commenced on acetazolamide. She remained well and asymptomatic. Repeat fundus photography a month later showed complete resolution of papilledema.

Conclusion Postoperative pseudo-meningocele is uncommon and the exact incidence is unknown as most of these patients are asymptomatic. This case illustrates that pseudo-meningocele can cause raised intracranial pressure leading to recurrent syncope. It is important for clinician to recognise the varied clinical presentations of meningocele and pseudo-meningocele.

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