Cervical Myelopathy Due to Epidural Hematoma at the Cervicomedullary Junction Associated With Ventriculoperitoneal Shunt Overdrainage: A Case Report

Overview

Journal Brain Neurorehabil

Date 2023 Dec 4

PMID 38047090

Authors

Ji Woong Park

Junwon Park

Affiliations

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Abstract

We present a case of cervical myelopathy caused by epidural hematoma formation due to chronic cerebrospinal fluid overdrainage. A 55-year-old man who underwent ventriculoperitoneal (V-P) shunt surgery for normal pressure hydrocephalus presented with progressive weakness of both the upper and lower extremities. Magnetic resonance imaging (MRI) revealed compressive myelopathy at the cervicomedullary junction at the C1-C2 level caused by epidural hematoma formation due to intracranial hypotension (IH) caused by a complication of V-P shunt. He underwent decompressive laminectomy and hematoma removal at C1-C2 and replacement of the V-P shunt valve. Follow-up cervical spine MRI showed an improved state of severe central spinal stenosis at the C1-C2 level and an improved state of compression-related cord signal intensity change in the spinal cord. After surgical intervention and intensive rehabilitation, the patient showed clinical improvement. If cervical myelopathy is suspected in patients with a shunt, cord compression due to venous engorgement or hematoma caused by over-shunting and IH should be considered.

References

Wolfe S, Bhatia S, Green B, Ragheb J . Engorged epidural venous plexus and cervical myelopathy due to cerebrospinal fluid overdrainage: a rare complication of ventricular shunts. Case report. J Neurosurg. 2007; 106(3 Suppl):227-31. DOI: 10.3171/ped.2007.106.3.227. View

Amano E, Ozaki K, Egawa S, Suzuki M, Hirai T, Ishibashi S . Dynamic spinal compression revealed by computed tomography myelography in overshunting-associated myelopathy: A case report. Medicine (Baltimore). 2018; 97(10):e0082. PMC: 5882412. DOI: 10.1097/MD.0000000000010082. View

Wingerchuk D, Patel N, Patel A, Dodick D, Nelson K . Progressive cervical myelopathy secondary to chronic ventriculoperitoneal CSF overshunting. Neurology. 2005; 65(1):171-2. DOI: 10.1212/01.wnl.0000167289.14203.34. View

Vister E, Hammer S, Keunen R, Rijssenbeek A, Van Der Gaag N . Overshunting-Related Cervical Myelopathy Causing Progressive Gait Disturbance: A Case Report. Case Rep Neurol. 2021; 13(2):312-317. PMC: 8216007. DOI: 10.1159/000514551. View

Ho J, Law H, Yuen S, Yam K . Overshunting-associated myelopathy: report of 2 cases. Neurosurg Focus. 2016; 41(3):E16. DOI: 10.3171/2016.7.FOCUS16179. View

Liu J, Gottfried O, Brockmeyer D . Epidural venous engorgement resulting in progressive cervical myelopathy from shunt-related intracranial hypotension. Case report and review of the literature. J Neurosurg. 2006; 105(6 Suppl):499-503. DOI: 10.3171/ped.2006.105.6.499. View

Park E, Kim E . Spontaneous intracranial hypotension: clinical presentation, imaging features and treatment. J Korean Neurosurg Soc. 2009; 45(1):1-4. PMC: 2640824. DOI: 10.3340/jkns.2009.45.1.1. View

Ulrich N, Maier M, Bernays R, Krayenbuhl N, Kollias S . Cervical myelopathy due to chronic overshunting in a pediatric patient: case report and review of the literature. Turk Neurosurg. 2013; 23(3):410-4. DOI: 10.5137/1019-5149.JTN.5604-11.0. View

Akiba C, Bandai H, Ito Y, Maeda T, Yamaguchi K, Nakajima M . Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case report. BMC Neurol. 2020; 20(1):151. PMC: 7181568. DOI: 10.1186/s12883-020-01697-1. View

10.

Vidal P, Ulndreaj A, Badner A, Hong J, Fehlings M . Methylprednisolone treatment enhances early recovery following surgical decompression for degenerative cervical myelopathy without compromise to the systemic immune system. J Neuroinflammation. 2018; 15(1):222. PMC: 6080373. DOI: 10.1186/s12974-018-1257-7. View