VP Shunt Overdrainage Linked Myelopathy - A Rare Complication

Abstract

Cerebrospinal fluid over drainage after placement of a VP shunt is a common but poorly recognized problem. This excess leak can lead to cervical myelopathy, a very late complication, the pathogenesis of which is linked to the compensatory engorgement of the venous plexus secondary to the fluid over drainage. We present a case of a 32-year-old male who was diagnosed with tubercular meningitis and obstructed hydrocephalus, for which he was treated with ventriculoperitoneal shunting in 2009, and now in 2022 he presented with complaints of weakness and stiffness in both the legs. The diagnosis of CSF over drainage due to VP shunt was made radiologically. The VP shunt was subsequently removed, and the patient gradually improved in 6 months. VPS (Ventriculoperitoneal Shunt) is a neurosurgical procedure that is commonly done for the treatment of hydrocephalus. Despite being one of the commonest interventions performed, it can lead to various complications, and their rates are yet undetermined.[1] These include shunt obstruction, infection, abdominal pseudocyst, bowel perforation, subdural collection, and over-draining of cerebrospinal fluid.[2] Out of all, cerebrospinal fluid over drainage after the surgery is a common but poorly recognized problem.[3] This excess leak can lead to cervical myelopathy, a very late complication, the pathogenesis of which is linked to the compensatory engorgement of the venous plexus secondary to the fluid over drainage.[4] The medical literature dates back to 1988, when chronic over-shunting of CSF was first described by the Miyazaki, and therefore it is sometimes referred to as Miyazaki syndrome.[4] Here, we describe a case of a young patient who developed a delayed constellation of neurological symptoms after the VPS, which were associated with the radiologically identified shunt malfunctioning and cord pathology.