Treatable Spastic Tetraparesis Caused by Overshunting-associated Myelopathy

Internal Medicine, 2023 · DOI: 10.2169/internalmedicine.1655-23 · Published: May 10, 2023

Simple Explanation

A 37-year-old woman with a history of hydrocephalus and ventriculoperitoneal shunt surgery presented with worsening gait disturbance over a 3-year period. She was diagnosed with overshunting-associated myelopathy (OSAM), a condition characterized by compression of the upper cervical spinal cord due to low cerebrospinal fluid pressure. The patient underwent ventriculoperitoneal shunt ligation, which led to improvement in her symptoms and the ability to ambulate.

Study Duration

3 years

Participants

A 37-year-old woman

Evidence Level

Not specified

Key Findings

1
The patient presented with right-sided significant spastic tetraparesis.
2
Brain MRI revealed diffuse pachymeningeal enhancement, thickening of the inner table of the skull, and oval deformation of the upper cervical cord due to an engorged epidural venous plexus.
3
Following shunt ligation, dilatation of the epidural venous plexus was reduced, and the spinal cord deformity improved, leading to the abatement of spasticity.

Research Summary

This case report describes a 37-year-old woman with worsening gait disturbance due to overshunting-associated myelopathy (OSAM) following ventriculoperitoneal shunt surgery for hydrocephalus. Diagnosis was confirmed by neurological examination and brain MRI, which revealed characteristic features of OSAM, including spinal cord compression and epidural venous plexus dilation. Shunt ligation led to significant improvement in the patient's symptoms and radiographic findings, highlighting the treatable nature of OSAM.

Practical Implications

Diagnostic Awareness

OSAM should be considered in patients with VP shunts who present with spastic deterioration.

Treatment Strategy

Shunt ligation can be an effective treatment for OSAM.

Radiological Evaluation

Brain MRI with attention to the cervical spine is crucial for diagnosing OSAM.

Study Limitations

1
Single case report limits generalizability.
2
Long-term outcomes of shunt ligation not reported.
3
Not specified

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