Presentation
Ventriculoperitoneal shunt for posterior fossa tumor, headaches and weakness in the arms and legs.
Patient Data
Contrast-enhanced head CT showing bilateral chronic subdural collections, engorged dural veins and sinuses, and thin optic nerve sheaths, in keeping with cerebral hypotension from chronic over-shunting.
Dilated epidural veins with no signs of spinal cord compression in this study.
Chronic lesions in the posterior fossa with a ventriculoperitoneal shunt in place at the right lateral ventricle.
Case Discussion
On the basis of the clinical picture and history, and the CT scan revealing signs indicative of intracranial hypotension from cerebrospinal fluid overshunting, the diagnosis of Miyazaki syndrome (Overshunting-associated myelopathy) was proposed.
This entity was first described in 1998 by Miyazaki1, a Japanese neurologist, in a patient with a ventriculoperitoneal shunt and a dilated epidural venous system at the level of the cervical spinal cord accompanied by low cerebrospinal fluid (CSF) pressure and signs of upper cervical myelopathy as a result of venous compression.
It is a rare complication of VP shunts, with very few publications in the literature 2.
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