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Spine (Phila Pa 1976) 34:955-963, 2009. 31. Zileli M, Kilincer C, Ersahin Y, Cagli S: Primary tu- mors of the cervical spine: a retrospective review of 35 surgically managed cases. Spine J 7:165-173, 2007. received 15 November 2009; accepted 10 May 2010 Citation: World Neurosurg. (2010) 74, 2/3:363-368. DOI: 10.1016/j.wneu.2010.05.034 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter © 2010 Elsevier Inc. All rights reserved. Tardy Spinal Cord Tumor Following Avulsive Brachial Plexus Injury: Coincidental or Causal? Marie-Noëlle Hébert-Blouin 1 , Allen T. Bishop 2 , Alexander Y. Shin 2 , Cynthia Wetmore 3 , Robert J. Spinner 1,2 INTRODUCTION Late neurologic deterioration after a brachial plexus injury (BPI) is uncommon. Several cases have been reported caused by multiple etiologies including intraspinal extradural pseudomeningocele causing spinal cord compression (6, 12, 18, 19, 34, 36), spinal cord tethering at the level of nerve root avulsion (32), intradural arachnoid cyst and adhesions (6, 28), spinal cord herniation into a preexist- ing pseudomeningocele (9, 43), superficial siderosis (1, 4, 5, 8, 11, 22, 23, 25, 27, 31, 39), and syringomyelia (10). Two other possibili- ties that have been suggested but not reported include the development of 1) a “post-polio syndrome” (21) whereby late neurologic dete- rioration could result from ongoing apopto- sis or from the natural dropout of neurons in a spinal cord with an initially reduced neuronal pool (secondary to retrograde neuronal loss from severe BPI or secondary to concomitant  OBJECTIVE: 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.  METHODS: A pediatric patient previously treated for a traumatic pregangli- onic BPI and presenting with neurologic deterioration 5 years after his injury is reviewed.  RESULTS: 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 astrocy- toma. Despite craniospinal radiotherapy and different regimens of chemotherapy, he died 4 years later from leptomeningeal spread.  CONCLUSION: This case illustrates a previously unreported cause of late neurologic deterioration following BPI. The probable coincidental versus possi- ble causal interrelationship of these two processes (BPI and spinal cord tumor) is discussed, but no conclusions can be reached. Key words  Astrocytoma  Brachial plexus injury  Spinal cord tumor Abbreviations and Acronyms BPI: Brachial plexus injury FSE: Fast spin echo MRC: Medical Research Council MRI: Magnetic resonance imaging From the Departments of 1 Neurologic Surgery, 2 Orthopedics, and 3 Neurology, Mayo Clinic, Rochester, Minnesota, USA To whom correspondence should be addressed: Robert J. Spinner, M.D. [E-mail: spinner.robert@mayo.edu] Citation: World Neurosurg. (2010) 74, 2/3:368-373. DOI: 10.1016/j.wneu.2010.05.005 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter © 2010 Elsevier Inc. All rights reserved. PEER-REVIEW REPORTS MARIE-NOËLLE HÉBERT-BLOUIN ET AL. SPINAL CORD TUMOR AFTER BRACHIAL PLEXUS INJURY 368 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, DOI:10.1016/j.wneu.2010.05.005