Elavarasi Arunmozhimaran, Dash Deepa, Singh Pankaj Kumar, Tripathi Manjari
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Ann Indian Acad Neurol. 2020 Jul-Aug;23(4):536-538. doi: 10.4103/aian.AIAN_431_18. Epub 2019 Mar 5.
Normal-sized ventricles and absence of papilledema do not rule out shunt failure and raised intracranial pressure (ICP). Raised ICP can present with false localizing signs which may be cranial nerve palsies or extensive polyradiculopathy. Our patient with a history of ventriculoperitoneal (VP) shunt presented with rapidly progressive vision loss without papilledema, as well as multiple cranial nerve palsies and radiculopathy. Imaging did not reveal hydrocephalus, however, cerebrospinal fluid (CSF) manometry revealed high CSF opening pressure. After lumbar thecoperitoneal shunting, vision did not improve, but the rest of cranial nerve palsies and radiculopathy improved. In a patient in whom VP shunt is , headache and vomiting should prompt evaluation for raised ICP though there is no ventriculomegaly of papilledema. Vision can be saved if raised ICP is suspected, CSF opening pressure measured at presentation and prompt surgery is performed.
脑室大小正常且无视乳头水肿并不能排除分流失败和颅内压（ICP）升高。ICP升高可能表现为假性定位体征，可能是脑神经麻痹或广泛的多发性神经根病。我们这位有脑室腹腔（VP）分流病史的患者出现了快速进展的视力丧失且无视乳头水肿，以及多发性脑神经麻痹和神经根病。影像学检查未发现脑积水，然而，脑脊液（CSF）测压显示脑脊液初压升高。在进行腰大池腹腔分流术后，视力并未改善，但其余的脑神经麻痹和神经根病有所改善。对于有VP分流的患者，尽管没有脑室扩大或视乳头水肿，但头痛和呕吐应促使对ICP升高进行评估。如果怀疑ICP升高、在就诊时测量脑脊液初压并及时进行手术，视力是可以挽救的。
