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Reversible Severe Brainstem Herniation and Obstructive Hydrocephalus from Cystoperitoneal Shunt Overdrainage

Joyce Koueik1, Sarah Kawtharani2, Bermans J Iskandar1

  • 1Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA.

World Neurosurgery
|April 2, 2019
PubMed

Insights

Symptomatic intracranial hypotension caused by CSF overdrainage from a cystoperitoneal shunt can lead to obstructive hydrocephalus. Shunt occlusion resolved symptoms, midbrain distortion, and hydrocephalus in this case.

Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Cystoperitoneal shunts are used to treat cerebrospinal fluid (CSF) accumulation.
  • Overdrainage of CSF can lead to various neurological complications.
  • Intracranial hypotension is a potential complication of CSF shunting procedures.

Observation:

  • A patient presented with symptomatic intracranial hypotension.
  • The hypotension was secondary to excessive CSF drainage via a cystoperitoneal shunt.
  • Brain MRI revealed midbrain distortion and cerebral aqueduct occlusion.

Findings:

  • The observed midbrain distortion led to obstructive hydrocephalus.
  • Symptoms of intracranial hypotension and hydrocephalus were directly linked to shunt function.
  • Successful management involved occlusion of the cystoperitoneal shunt.

Implications:

  • This case highlights the critical need for careful management of CSF shunt systems.
  • Understanding shunt dynamics is crucial for preventing complications like obstructive hydrocephalus.
  • Shunt occlusion can be an effective treatment for CSF overdrainage-induced complications.
Keywords:
Arachnoid cystBrainstem distortionCSF shuntsIntracranial hypotension

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