Rapidly Deteriorating Degenerative Cervical Myelopathy Following Ventricular Shunt Revision for Hydrocephalus: Case Report.
Tanzil RujeedawaOliver Daniel MowforthMark Reinhard KotterBenjamin Marshall DaviesPublished in: Interactive journal of medical research (2023)
A female patient in her early 40s presented with a several-month history of gait unsteadiness and dragging her left leg. She had a background of congenital hydrocephalus, treated with a ventriculoatrial shunt. On examination, she had increased tone and brisk reflexes in the lower limbs and a positive Hoffmann sign. A computed tomography (CT) scan and shunt series x-rays identified hydrocephalus secondary to a disconnected shunt. Magnetic resonance imaging (MRI) of her cervical spine was also performed as part of the workup for her presenting symptoms and demonstrated features compatible with degenerative cervical myelopathy (DCM). The patient subsequently underwent a shunt revision. Following the operation, her walking and hand function deteriorated over a period of several weeks. She consequently underwent an anterior cervical decompression and fusion for DCM, which partially improved her symptoms. The sequence of events suggests that the shunt surgery may have precipitated a worsening of the DCM. Possible explanations include spinal cord injury related to neck extension or hypoperfusion during intubation and general anesthesia or the loss of cerebrospinal fluid cushioning following the reinstitution of effective cerebrospinal fluid shunting. Surgeons should be alert to this possibility and offer prompt surgical intervention for DCM if required.
Keyphrases
- cerebrospinal fluid
- case report
- computed tomography
- magnetic resonance imaging
- pulmonary artery
- contrast enhanced
- spinal cord injury
- spinal cord
- total knee arthroplasty
- subarachnoid hemorrhage
- positron emission tomography
- pulmonary hypertension
- randomized controlled trial
- coronary artery
- heart failure
- cardiac arrest
- image quality
- left ventricular
- magnetic resonance
- physical activity
- pulmonary arterial hypertension
- sleep quality
- diffusion weighted imaging
- quality improvement
- coronary artery disease
- clinical decision support
- cognitive impairment
- depressive symptoms
- brain injury