Epidural venous engorgement resulting in progressive cervical myelopathy from shunt-related intracranial hypotension: Case report and review of the literature

James Liu, Oren N. Gottfried, Douglas L. Brockmeyer

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)499-503
Number of pages5
JournalJournal of Neurosurgery
Volume105 PEDIATRICS
Issue numberSUPPL. 6
StatePublished - Dec 1 2006
Externally publishedYes

Fingerprint

Intracranial Hypotension
Spinal Cord Diseases
Hyperemia
Cerebrospinal Fluid Pressure
Veins
Cerebrospinal Fluid Shunts
Quadriplegia
Spinal Puncture
Muscle Spasticity
Hypesthesia
Fluid Therapy
Gait
Neuroimaging
Headache
Cysts
Pressure
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

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abstract = "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.",
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Epidural venous engorgement resulting in progressive cervical myelopathy from shunt-related intracranial hypotension : Case report and review of the literature. / Liu, James; Gottfried, Oren N.; Brockmeyer, Douglas L.

In: Journal of Neurosurgery, Vol. 105 PEDIATRICS, No. SUPPL. 6, 01.12.2006, p. 499-503.

Research output: Contribution to journalReview article

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