著者

髙石 吉將 荒井 篤 岡田 真幸 藤原 大悟 鵜山 淳 近藤 威

出版者

日本脊髄外科学会

雑誌

脊髄外科 (ISSN:09146024)

巻号頁・発行日

vol.33, no.2, pp.179-183, 2019 (Released:2019-09-10)

参考文献数

16

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Various complications are found in ventriculo-peritoneal shunts (V-P shunts) used in hydrocephalus. Overdrainage can be the source of some of these complications and is the primary cause of orthostatic headache, nausea, and vomiting. Here, we report a case of overshunting-associated myelopathy with progressive tetraparesis. A 56 year-old female had undergone placement of a V-P shunt four years prior to presentation in our clinic. She presented with progressive spastic tetraparesis and dysarthria but had no headache. In a brain magnetic resonance image (MRI), enlargement of the bilateral subdural space was noted. Gadolinium enhanced MRI showed dural enhancement. The presence of intracranial hypotension was suspected. Engorgement of the epidural vein at the C2 level in the cervical epidural space was also observed in the gadolinium enhanced cervical MRI. Since overdrainage of the V-P shunt was obviously present, a programmable valve was placed, and the flow of cerebrospinal fluid was controlled. The symptoms improved, and the epidural enhanced lesion diminished in subsequent MRIs. Here, we report a case of overshunting-associated myelopathy after placement of a V-P shunt and a review of the currently available literature.

著者

荒井 篤子

出版者

一般社団法人社会情報学会

雑誌

日本社会情報学会学会誌 (ISSN:09151249)

巻号頁・発行日

vol.16, no.2, 2004-09-30

著者

中村 直人 高石 吉將 荒井 篤 鵜山 淳 近藤 威 岩橋 洋文

出版者

日本脊髄外科学会

雑誌

脊髄外科 (ISSN:09146024)

巻号頁・発行日

vol.32, no.3, pp.329-333, 2018 (Released:2019-01-24)

参考文献数

16

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A 49-year-old man with lumbar spinal lipoma was surgically treated because of intractable pain. The lipoma was originally asymptomatic and found incidentally 10 years before. He began to have occasional dysesthesia in the right lower limb 8 years before. The symptom became severe 1 year before he visited our hospital for the first time. The dysesthesia was in the L5 region of his right lower limb. Muscle weakness and urinary incontinence were not found. The magnetic resonance imaging demonstrated low-set conus (L3/L4) associated with spinal lipoma, which extended from the extradural part (from L4/L5 to L5/S1) to the intradural part (from L2/L3 to L3/L4). Computed tomography revealed hypoplasia in the laminae of L4, L5, and S1. We observed him for a year, and the dysesthesia became intolerable while the lipoma size was unchanged. Untethering was performed with L2-L5 laminectomy. The extradural part of the lipoma was completely removed with the adhered dural membrane. The intradural part was detached from dural membrane and partially removed. A GORE-TEX patch was used for dural membrane closure. The mechanism of adult-onset spinal lipoma is considered tethered cord syndrome or spinal cord compression. As spinal lipoma is usually adhered with the spinal cord, the appropriate surgical strategy seems to be untethering and partial resection of the lipoma.