脳室腹腔短絡術後overshunting-associated myelopathyの1例

抄録

　　Various complications are found in ventriculo-peritoneal shunts (V-P shunts) used in hydrocephalus. Overdrainage can be the source of some of these complications and is the primary cause of orthostatic headache, nausea, and vomiting. Here, we report a case of overshunting-associated myelopathy with progressive tetraparesis.

　　A 56 year-old female had undergone placement of a V-P shunt four years prior to presentation in our clinic. She presented with progressive spastic tetraparesis and dysarthria but had no headache. In a brain magnetic resonance image (MRI), enlargement of the bilateral subdural space was noted. Gadolinium enhanced MRI showed dural enhancement. The presence of intracranial hypotension was suspected. Engorgement of the epidural vein at the C2 level in the cervical epidural space was also observed in the gadolinium enhanced cervical MRI.

　　Since overdrainage of the V-P shunt was obviously present, a programmable valve was placed, and the flow of cerebrospinal fluid was controlled. The symptoms improved, and the epidural enhanced lesion diminished in subsequent MRIs.

　　Here, we report a case of overshunting-associated myelopathy after placement of a V-P shunt and a review of the currently available literature.