Progressive cervical myelopathy secondary to chronic ventriculoperitoneal CSF overshunting

Abstract

CSF hypovolemia typically causes orthostatic headache with or without nonlocalizing symptoms such as neck pain, nausea, aural fullness, and dizziness.1 Focal complications are rare and are usually secondary to subdural hematoma. We report findings from a patient with progressive cervical myelopathy associated with cord distortion due to dural thickening and tortuous venous dilation. Chronic CSF hypotension caused by excessive ventriculoperitoneal shunting seemed to be the primary etiology. A 72-year-old woman presented for evaluation of an undiagnosed gait disorder. Twenty-seven years earlier she underwent right suboccipital craniectomy and ventriculoperitoneal shunt placement for a posterior fossa meningioma. There was no tumor recurrence or shunt malfunction. Four years earlier, she noted the insidious onset of right lower extremity spastic monoparesis. During the year prior to presentation, she developed bilateral leg and right arm weakness, left upper extremity numbness, and urinary urge incontinence. She denied headache, neck and shoulder pain, and orthostatic symptoms. Examination revealed a moderately severe, right-predominant, asymmetric spastic quadriparesis with generalized hyperreflexia, bilateral extensor plantar responses, and mild …