Cervical extramedullary mass lesion due to chronic CSF overshunting: case report and literature review.
BACKGROUND
Several emerging clinical and neuroimaging conditions due to CSF intracranial hypotension have been documented. Recently, a few instances of a severe form of cervical myelopathy due to CSF overshunting have also been reported. Patients with this type of cervical myelopathy usually evolve with marked clinical manifestations of spinal cord involvement.


METHODS
In this article, we report a 20-year-old girl, previously given a ventriculoperitoneal shunt at age 6 years, who presented with neck pain after a whiplash injury.


CONCLUSIONS
Magnetic resonance imaging revealed a cervical extramedullary mass that mimicked a cervical extradural hematoma. Further neuroimaging studies demonstrated that it corresponded to an engorged cervical epidural venous plexus that we attributed to chronic CSF overdrainage. After expectant management, the patient experienced a total recovery of her symptoms. To our knowledge, this is the first report of this condition occurring in an asymptomatic patient. Our aim in reporting this patient is twofold: (1) to warn the clinician about these neuroimaging findings that may mimic a cervical extradural hematoma and (2) to illustrate that engorged cervical epidural plexus may occur in patients in the absence of clinical manifestations of myelopathy. Recognition of this entity is important to distinguish it from a mass lesion in which a surgical intervention might be indicated.
Martínez-Lage
Juan F
JF
Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, El Palmar, E-30120, Murcia, Spain. juanf.martinezlage@cablemurcia.com
Alarcón
Fernando
F
Alfaro
Raúl
R
Ruíz-Espejo
Antonio
A
López-Guerrero
Antonio López
AL
Hernández-Abenza
José
J
D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002574:Cervical Vertebrae; D003937:Diagnosis, Differential; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D019547:Neck Pain / Q000209:etiology; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000473:pathology; D013131:Spine / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000150:complications; D055815:Young Adult