Rujeedawa Tanzil, Mowforth Oliver, Kotter Mark, Davies Benjamin
Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.
Interact J Med Res. 2023 Aug 28;12:e48222. doi: 10.2196/48222.
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 shunt. On examination, she had increased tone and brisk reflexes in the lower limbs and a positive Hoffmann sign. A computed tomography (CT) scan and shunt series x-rays 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 (DCM). 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 for 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 or hypoperfusion during intubation and general anesthesia or the loss of cerebrospinal fluid cushioning following the reinstitution of effective cerebrospinal fluid shunting. Surgeons should be alert to this possibility and offer prompt surgical intervention for DCM if required.
一名40岁出头的女性患者，有几个月步态不稳和左腿拖地的病史。她有先天性脑积水病史，曾接受脑室-心房分流术治疗。检查发现，她下肢肌张力增加、反射亢进，霍夫曼征阳性。计算机断层扫描（CT）和分流系列X线检查发现分流管断开导致继发性脑积水。作为对其现有症状检查的一部分，还对她进行了颈椎磁共振成像（MRI）检查，结果显示符合退行性颈椎脊髓病（DCM）的特征。该患者随后接受了分流管修复术。术后几周内，她的行走和手部功能恶化。因此，她又接受了针对DCM的颈椎前路减压融合术，症状得到部分改善。这一系列事件表明，分流手术可能促使DCM病情恶化。可能的解释包括插管和全身麻醉期间颈部伸展或灌注不足导致的脊髓损伤，或重新建立有效的脑脊液分流后脑脊液缓冲作用丧失。外科医生应警惕这种可能性，并在必要时为DCM提供及时的手术干预。
