Document Detail

Epidural venous engorgement resulting in progressive cervical myelopathy from shunt-related intracranial hypotension. Case report and review of the literature.
MedLine Citation:
PMID:  17184086     Owner:  NLM     Status:  MEDLINE    
The authors report an unusual case of engorged epidural veins causing progressive cervical myelopathy after long-term cerebrospinal fluid (CSF) shunt therapy and intracranial hypotension. An 18-year-old woman, who had previously undergone shunt placement with a distal slit valve for a porencephalic cyst when 2 years of age, presented with progressive spastic quadriparesis, numbness, and gait difficulty. Postural headaches were absent and a lumbar puncture revealed low CSF pressure. Neuroimaging disclosed markedly engorged anterior epidural veins causing compression of the cervical spinal cord. The slit-valve shunt system was surgically removed and an external drain was placed. The patient's CSF pressure was gradually raised to clinically tolerable levels. Once the optimal pressure was identified, a programmable shunt was placed with the valve set at the same level. The patient's neurological status improved, and the epidural veins had returned to their normal size on follow-up imaging. The authors describe the unique treatment strategy used in this patient and review the literature on epidural venous engorgement as it relates to intracranial hypotension.
James K Liu; Oren N Gottfried; Douglas L Brockmeyer
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  105     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-12-22     Completed Date:  2007-01-18     Revised Date:  2007-04-02    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  499-503     Citation Subset:  AIM; IM    
Department of Neurosurgery, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City, Utah 84113, USA.
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MeSH Terms
Central Nervous System Cysts / surgery
Cerebrospinal Fluid Shunts / adverse effects*
Epidural Space / blood supply*,  pathology
Intracranial Hypotension / etiology*,  pathology,  surgery*
Magnetic Resonance Imaging
Veins / pathology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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