No abstract

Cerebrospinal fluid ascites following ventriculo- peritoneal shunting for hydrocephalus is a very rare complication. We present the first case at our hospital. A 3year old female with communicating hydrocephalus presented with massive ascites. It recurred with 2-3weeks of ascitic tap to dryness. Other possible causes of ascites were excluded by normal renal and liver function tests and clinically normal cardiac function. Tests done on the ascitic fluid showed that it was consistent with cerebrospinal fluid with no signs of infection. CT abdomen excluded abdominal masses and CSF pseudo-cyst. A ventriculo-Atrial shunt was done and the ascites slowly regressed over the next 2-3 weeks with no recurrence. The reason why the peritoneum failed to absorb the CSF was not established.

Cervical meningomyelocoele is a rare neural tube defect accounting for 1-5% of all neural tube defects. Very few cases have been reported in literature. We present a 4day old female patient who presented with a cervical cystic lesion. There was no CSF leakage or sign of infection at presentation. On further evaluation, other congenital abnormalities were excluded by thorough clinical and radiological examination. The patient had normal movement in all four limbs pre-operatively. Intra-operatively, the CSF filled cystic lesion had a hollow fibro-neurovascular stalk extending through the vertebral defect at the level C2-C3. This stalk is thought to be non-functional in most cases in literature but because we could not establish functional status, the hollow stalk was repaired and buried in the surrounding tissue after dura repair. Intra-dural exploration was done to remove adhesions up to the level of the defect to reduce the risk of tethered spinal cord syndrome. Post-operatively, the patient had full power in all limbs with no CSF leak or surgical site infection.

Cervical spine meningiomas are uncommon. They present with motor, sensory and other nonspecific symptoms like pain. We present a first case at our hospital. A 33yr old female presented with 5months history of spastic quadriparesis, gait ataxia and pain and forceful contractions of the left upper limb. She had been seen in different health centres and diagnosed as conversion disorder. Brain CT was normal, C-spine CT showed a 2*3cm homogenous lesion at C2-C3.Simpsons 2 resection was done with no complications. Post-operative physical rehabilitation with physiotherapy was instituted with good recovery. By 6 weeks' post-operative, she was ambulating without support.