Overshunting-Related Cervical Myelopathy Causing Progressive Gait Disturbance: A Case Report

• Published in: Case reports in neurology Vol. 13; no. 2; pp. 312 - 317
• Main Authors: Vister, Eva, Hammer, Sebastiaan, Keunen, Rudolf W.M., Rijssenbeek, Astrid L., van der Gaag, Niels A.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.06.2021; Karger Publishers
• Subjects: Ataxia; Case reports; Compression therapy; Cysts; Gait; gait disturbance; Hematoma; Hydrocephalus; Infections; intracranial hypotension; Intracranial pressure; Medical imaging; myelopathy; Single Case – General Neurology; Single Case − General Neurology; Spinal cord; Veins & arteries; venous plexus; ventriculoperitoneal shunt; Intracranial hypotension; Gait disturbance; Myelopathy; Venous plexus; Ventriculoperitoneal shunt
• ISSN: 1662-680X; 1662-680X
• DOI: 10.1159/000514551

Abstract A complication of ventriculoperitoneal (VP) shunting is overdrainage or overshunting of cerebrospinal fluid, which can cause formation of hygroma but in rare cases also cervical myelopathy at a later stage. In this article, we describe a very late complication of VP shunting. We present a 75-year-old man, previously given a VP shunt at the age of 46, who developed a progressive gait disturbance and ataxia of the limbs after 27 years. MRI showed a cervical stenosis and myelopathy as a result of venous engorgement due to chronic overshunting of the VP shunt. Revision of the VP shunt resulted in complete resolution of his neurological symptoms and the cervical myelopathy. Cervical myelopathy due to chronic overshunting is a rare and potentially very late complication of a VP shunt. Our case underlines the importance of awareness of this complication while proper treatment can reverse the associated symptoms fully.