Agrawal Deepak, Durity Felix A
Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada.
Pediatr Neurosurg. 2006;42(3):165-7. doi: 10.1159/000091860.
The authors describe a child with a ventriculo-peritoneal shunt in place for 5 years who presented with 'postural' seizures (seizures on sitting upright, which resolved on recumbency). On shunt tap, the cerebrospinal fluid was obtained freely, but required gentle aspiration with a syringe in the recumbent position, suggesting very low intracranial pressure. Contrast magnetic resonance imaging showed pachymeningeal enhancement and enlargement of the pituitary gland diagnostic of intracranial hypotension along with well-decompressed ventricles. At the time of revision of the shunt, no evidence of malfunction was found and the valve was changed to one with a higher opening pressure. Following this, she became asymptomatic and seizure free. This case illustrates the fact that following shunting, intracranial hypotension may also predispose to seizures, and should be kept in mind while managing these patients.
作者描述了一名脑室-腹腔分流术已实施5年的儿童，该患儿出现“姿势性”癫痫发作（直立坐位时发作，卧位时缓解）。在分流管穿刺时，脑脊液可自由获取，但在卧位时需要用注射器轻轻抽吸，提示颅内压极低。对比磁共振成像显示硬脑膜强化和垂体增大，诊断为颅内低压，同时脑室已充分减压。在分流管翻修时，未发现故障迹象，将瓣膜更换为开启压力更高的瓣膜。此后，她无症状且无癫痫发作。该病例说明了这样一个事实，即分流术后颅内低压也可能易引发癫痫，在处理这些患者时应予以考虑。
