title: Engorged epidural venous plexus and cervical myelopathy due to cerebrospinal fluid overdrainage: a rare complication of ventricular shunts. Case report.
abstract: The authors report on a 17-year-old boy with cervical myelopathy from dilated epidural veins due to cerebrospinal fluid (CSF) overdrainage. The patient had a long-standing subdural-peritoneal shunt and presented with incapacitating spastic tetraparesis. Magnetic resonance imaging revealed significant cervical spinal cord compression from a markedly dilated epidural venous plexus. The shunt was externalized so that CSF flow dynamics could be assessed, and the patient was found to have low intracranial pressure (ICP). The patient was gradually acclimated to higher ICPs, and a new shunt was placed with an antisiphon device and a programmable valve set at the higher pressure. Postoperatively the child experienced significant clinical improvement, and reduction of spinal cord compression was evident on images. Compensatory engorgement of the epidural venous plexus due to long-term shunt usage should be considered in the differential diagnosis when cervical myelopathy due to a dilated epidural venous plexus is present.
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Miami and Miami Children's Hospital, Miami, Florida 33136, USA.
authors.forename: Stacey Quintero
authors.initials: SQ
authors.lastname: Wolfe
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Bhatia
authors.forename: Barth
authors.initials: B
authors.lastname: Green
authors.forename: John
authors.initials: J
authors.lastname: Ragheb
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae; D004824:Epidural Space / Q000098:blood supply*; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D006940:Hyperemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*