✓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.
Abbreviations used in this paper:CSF = cerebrospinal fluid; CT = computed tomography; MR = magnetic resonance; SIH = spontaneous intracranial hypotension.
Address reprint requests to: Douglas L. Brockmeyer, M.D., Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah School of Medicine, Primary Children’s Medical Center, 100 North Medical Drive, Salt Lake City, Utah 84113. email:
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ClarotF, CallonnecF, DouvrinF, HannequinD, SimonetJ, ProustB, : Giant cervical epidural veins after lumbar puncture in a case of intracranial hypotension. AJNR Am J Neuroradiol21:787–789, 2000)| false
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