JMIR Publications

ABSTRACT

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 (VA) shunt. On examination, she had increased tone and brisk reflexes in the lower limbs, but also a positive Hoffmann’s sign. A computed tomography (CT) scan and shunt series x-ray 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. 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 (ACDF) for degenerative cervical myelopathy (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 and/or hypoperfusion during intubation and general anesthesia, or loss of CSF cushioning following re-institution of effective cerebrospinal fluid shunting. Surgeons should be alert to this possibility and offer prompt surgical intervention for DCM if required.