title: Over-shunting associated myelopathy.
abstract: Intracranial hypotension typically presents following cerebrospinal fluid (CSF) leak, but can be induced by CSF diversion. Classically, patients present with positional headache, but less common symptoms include neck pain and cranial nerve palsies. To our knowledge, the neurosurgical literature contains six reports of patients with symptomatic cervical, epidural venous plexus engorgement as the result of CSF shunting. The patient presented herein is a 26-year-old woman with shunt-dependent, congenital hydrocephalus. She presented with rapidly progressive cervical myelopathy following ventriculoperitoneal shunt revision. Imaging revealed engorgement of the cervical epidural venous plexus and mass effect on the cervical spinal cord. "Over-shunting associated myelopathy" is a rare complication of CSF diversion that should be familiar to physicians who routinely evaluate patients with intracranial shunts.
authors: Department of Neurological Surgery, Emory University School of Medicine, 1365-B Clifton Road, NE, Ste. 2200, Atlanta, GA 30322, USA. Electronic address: brian.howard@emory.edu.
authors: Brian M
authors: BM
authors: Howard
authors: Department of Neurological Surgery, Emory University School of Medicine, 1365-B Clifton Road, NE, Ste. 2200, Atlanta, GA 30322, USA.
authors: Eric A
authors: EA
authors: Sribnick
authors: Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
authors: Sanjay S
authors: SS
authors: Dhall
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology / Q000628:therapy*; D013116:Spinal Cord / Q000473:pathology; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
keywords: Hydrocephalus; Intracranial hypotension; Myelopathy; Ventriculoperitoneal shunt