{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T10:07:11Z","timestamp":1783937231727,"version":"3.55.0"},"reference-count":16,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Posterior cervical fusion is commonly performed for cervical spine instability and fractures. However, dural injury may result in cerebrospinal fluid leakage, pseudomeningocele, and, rarely, hydrocephalus. These complications may lead to substantial neurological deterioration and functional decline. We report a rare case of severe cognitive impairment and dysphagia caused by postoperative CSF leakage-associated hydrocephalus after C1\u20132 fusion and highlight the role of comprehensive rehabilitation in functional recovery. Case presentation: A 67-year-old woman sustained a type III odontoid fracture and was initially managed with halo-vest immobilization. Because of fracture nonunion, posterior C1\u20132 fusion was performed. One month after surgery, she developed progressive mental status deterioration, confusion, and severe functional impairment. Brain computed tomography revealed progressive hydrocephalus, and cervical spine magnetic resonance imaging demonstrated a large posterior fluid collection consistent with pseudomeningocele. Revision surgery and ventriculoperitoneal shunt placement were performed. However, the patient remained bedridden with persistent vomiting, severe cognitive impairment, dysphagia requiring nasogastric tube feeding, and generalized deconditioning. Three months after revision surgery, her neurological condition stabilized and rehabilitation was initiated. Intensive and individualized rehabilitation, including cognitive rehabilitation, swallowing therapy was implemented. After three months of rehabilitation, the patient demonstrated gradual improvement in cognitive function, swallowing function, and mobility, ultimately achieving independent standing and ambulation using a walker. Conclusions: Postoperative CSF leakage-associated hydrocephalus and pseudomeningocele may lead to severe cognitive, swallowing, and functional impairments beyond structural complications alone. Comprehensive, individualized rehabilitation should be considered an essential component of care to maximize neurological and functional recovery.<\/jats:p>","DOI":"10.3390\/jcm15145470","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T08:53:58Z","timestamp":1783932838000},"page":"5470","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cognitive Impairment and Dysphagia Associated with Postoperative Hydrocephalus Secondary to Cerebrospinal Fluid Leakage After C1\u20132 Fusion: A Case Report"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1820-6816","authenticated-orcid":false,"given":"Pureum","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Daejeon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Jae","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Daejeon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongwon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Daejeon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6894-445X","authenticated-orcid":false,"given":"Sook Joung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Daejeon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s13018-014-0064-9","article-title":"Outcomes of surgery for unstable odontoid fractures combined with instability of adjacent segments","volume":"9","author":"Wang","year":"2014","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1177\/15910199221113714","article-title":"Management of postoperative cervical pseudomeningocele with percutaneous aspiration and epidural blood patch","volume":"30","author":"Schartz","year":"2024","journal-title":"Interv. Neuroradiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.nic.2014.01.001","article-title":"Radiologic evaluation and management of postoperative spine paraspinal fluid collections","volume":"24","author":"Jain","year":"2014","journal-title":"Neuroimaging Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"109s","DOI":"10.1177\/2192568216687769","article-title":"Rare Complications of Cervical Spine Surgery: Pseudomeningocoele","volume":"7","author":"Ailon","year":"2017","journal-title":"Glob. Spine J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"302","DOI":"10.31662\/jmaj.2024-0179","article-title":"Communicating Hydrocephalus Secondary to Pseudomeningocele following Cervical Spine Surgery: A Case Report","volume":"8","author":"Sakamoto","year":"2025","journal-title":"JMA J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"9686","DOI":"10.12998\/wjcc.v9.i31.9686","article-title":"Iatrogenic giant pseudomeningocele of the cervical spine: A case report","volume":"9","author":"Kim","year":"2021","journal-title":"World J. Clin. Cases"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1097\/00006123-200005000-00044","article-title":"Giant intraspinal pseudomeningoceles cause delayed neurological dysfunction after brachial plexus injury: Report of three cases","volume":"46","author":"Hader","year":"2000","journal-title":"Neurosurgery"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1177\/2192568218808293","article-title":"Outcomes of Halo Immobilization for Cervical Spine Fractures","volume":"9","author":"Isidro","year":"2019","journal-title":"Glob. Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Weng, Y.J., Cheng, C.C., Li, Y.Y., Huang, T.J., and Hsu, R.W. (2010). Management of giant pseudomeningoceles after spinal surgery. BMC Musculoskelet. Disord., 11.","DOI":"10.1186\/1471-2474-11-53"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1227\/00006123-198508000-00012","article-title":"Spinal cord compression due to postoperative cervical pseudomeningocele","volume":"17","author":"Hanakita","year":"1985","journal-title":"Neurosurgery"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s12987-025-00661-w","article-title":"Idiopathic normal pressure hydrocephalus: Associations between CSF biomarkers, clinical symptoms, and outcome after shunt surgery","volume":"22","author":"Saadaldeen","year":"2025","journal-title":"Fluids Barriers CNS"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1227\/NEU.0b013e31827414b3","article-title":"Poor cognitive outcome in shunt-responsive idiopathic normal pressure hydrocephalus","volume":"72","author":"Koivisto","year":"2013","journal-title":"Neurosurgery"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12987-024-00517-9","article-title":"Cerebrospinal fluid shunt surgery reduces the risk of developing dementia and Alzheimer\u2019s disease in patients with idiopathic normal pressure hydrocephalus: A nationwide population-based propensity-weighted cohort study","volume":"21","author":"Tseng","year":"2024","journal-title":"Fluids Barriers CNS"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1007\/s00586-022-07515-1","article-title":"A scoping review of the methods used to capture dysphagia after anterior cervical discectomy and fusion: The need for a paradigm shift","volume":"32","author":"Molfenter","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_15","first-page":"185","article-title":"Development of dysphagia and trismus developed after c1-2 posterior fusion in extended position","volume":"67","author":"Misawa","year":"2013","journal-title":"Acta Med. Okayama"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.clnu.2017.09.003","article-title":"ESPEN guideline clinical nutrition in neurology","volume":"37","author":"Burgos","year":"2018","journal-title":"Clin. Nutr."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5470\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T09:13:46Z","timestamp":1783934026000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5470"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,13]]},"references-count":16,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145470"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145470","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,13]]}}}