Presentation
Drop attacks, general fatigue and weight loss.
Patient Data
X-rays show an old ventriculoatrial shunt with massive calcifications. The shunt was expected to be dysfunctional and was neurosurgically-removed in order to conduct MRI studies.
Cerebral MRI showed periventricular plaques of unknown clinical significance.
MRI of the upper spine revealed ischemic changes of the cervical spinal cord (T2 hyperintense).
Case Discussion
A 41-year-old woman presented to the neurosurgical clinic with sudden drop attacks without prodrome or loss of consciousness. She complained about general fatigue, chronic neck pain and unexplained weight loss. The neurological exam demonstrated strong hyperreflexia, a bilateral positive Babinski sign and unstable gait. An externally-conducted CT of the head incidentally revealed a ventriculoatrial shunt, which the patient was unaware of. The shunt had probably been implanted in early infancy and due to fears of a negative socioeconomic impact the patient was never informed about its existence. Unfortunately, the patient was lost to follow-up.
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