Ventriculoperitoneal shunt failure causing myelopathy in a patient with bilateral jugular vein occlusion

Case report

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✓The authors describe the case of a 36-year-old woman with bilateral internal jugular vein occlusion, hydrocephalus, and Dandy–Walker variant who presented with myelopathy that was ultimately attributed to ventriculoperitoneal (VP) shunt failure. Computed tomography (CT) angiography of the head and neck revealed epidural venous engorgement within the cervical spine, greater that 50% narrowing of the C2–5 spinal canal, and compression of the cervical spinal cord. After successful shunt revision, postoperative CT angiography revealed decreased venous engorgement as well as decompression of the cervical spinal cord, and the patient’s myelopathy improved. This case represents a fascinating clinical presentation of VP shunt failure, highlighting the physiological importance of the external jugular pathways involved in cerebral venous drainage.

Abbreviations used in this paper:CT = computed tomography; IJV = internal jugular vein; VP = ventriculoperitoneal.

Article Information

Address reprint requests to: Timothy M. George, M.D., Pediatric Neurosurgery, Children’s Hospital of Austin, 1601 Rio Grande, Austin, Texas 78701. email: tmgeorge@seton.org.

© AANS, except where prohibited by US copyright law.

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Figures

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    Sagittal contrast-enhanced magnetic resonance image revealing a 7.3 × 3–cm posterior fossa cyst, dolichocephaly, partial agenesis of the corpus callosum, and cerebellar vermis hypoplasia, which are findings consistent with a history of hydrocephalus and Dandy–Walker variant.

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    Neuroimages obtained before shunt revision. A: Coronal 3D reconstructed CT angiogram of the cervical spine. The arrow denotes epidural venous distension and stenosis of the cervical canal from C-2 to C-5. B: Sagittal reconstructed CT scan revealing effacement of the ventral subarachnoid space from C-2 to C-5. C: Axial CT angiogram obtained at C-2, further revealing the prominent epidural venous plexus within the spinal canal and compression of the cervical spinal cord.

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    Neuroimages obtained after shunt revision. A: Coronal reconstructed 3D CT angiogram revealing decreased epidural venous distension and a reduction in stenosis of the cervical spinal canal (arrow). B: Sagittal CT reconstruction illustrating decreased epidural venous distension and cervical spinal cord compression. C: Axial CT scan at the C-2 level revealing decreased epidural venous distension and cervical spine compression.

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    Axial CT angiogram at C-2 obtained 5 months postoperatively, revealing an increase in epidural venous distension and spinal cord compression.

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