Cervical Myelopathy due to Chronic Overshunting in a Pediatric Patient

The authors present a rare situation of an engorged suboccipital epidural venous plexus due to chronic cerebrospinal fluid (CSF) overdrainage leading to cervical myelopathy. We report a case of a 17-year-old adolescent with obstructive hydrocephalus due to a retrocerebellar cyst and secondary implantation of a ventriculoperitoneal shunt (VP shunt). The patient presented with a progressive spastic tetraparesis without classical signs of overshunting leading away from the final diagnosis at the beginning. Magnetic resonance imaging revealed significant cervical spinal cord compression with myelopathy due to engorged epidural veins. Further assessment revealed a broken shunt valve with low-pressure setting. The VP shunt valve was changed with an additional antisiphon device. Postoperatively the intracranial pressure was raised gradually. After intensive physiotherapy the patient showed slight clinical improvement. Imaging revealed a distinct regression of the dilated venous plexus at the cranial-cervical junction with resolution of compression and deformation of the spinal cord within 9 days. Engorgement of the epidural venous plexus in long-term shunt patients should always be considered in the differential diagnosis even when classical clinical and radiological signs of overshunting are missing.