Massive CSF overshunting causing intracranial hypotension and bilateral chronic subdural hematomas

Case contributed by Youssef Sakhy
Diagnosis certain


Followed for hydrocephalus since birth and history of meningitis. Currently presents with apyretic seizures

Patient Data

Age: 9 months old
Gender: Female

Ventriculoperitoneal (VP) shunt in situ.

Slit-like 3rd and lateral ventricles with collapsed right parietal lobe, distended dural venous sinuses with bulging convex margins, associated to pachymeningeal enhancement, suggesting intracranial hypotension secondary to CSF overshunting. 

Bilateral chronic subdural hematomas with signs of acute bleeding on the right.

Case Discussion

Early rapid reduction in ventricular size is a cause of intracranial hypotension and thus may result in collapse of the brain and accumulation of fluid or blood around the brain. Most commonly, benign cerebrospinal fluid collections are observed; however, subdural hematomas are possible.

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