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 CASE REPORT
Year : 2014  |  Volume : 9  |  Issue : 2  |  Page : 132-135

Shunt malfunction presenting with symptomatic syringomyelia: Demonstrated on contrast ventriculogram


1 Department of Neurosurgery, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
2 Department of Neurosurgery, National Institute Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India

Correspondence Address:
T J Aniruddha
T. J, M. S. Ramaiah Medical College, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1817-1745.139313

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Ventriculoperitoneal (VP) shunt malfunction commonly presents as raised intracranial pressure. Rarely, when the central canal of the spinal cord communicates with the 4 th ventricle, shunt malfunction can present as an expanding syrinx. The diagnosis is often delayed, resulting in severe morbidity. Some of these patients undergo repeated syrinx surgeries without much benefits. We report a case of chronic tuberculous meningitis with shunt malfunction presenting as an expanding spinal canal syrinx and quadriparesis. Fourth ventricular communication with syrinx was demonstrated with the help of a contrast ventriculogram. After shunt revision, syrinx resolved completely and the patient made significant improvement in his neurological deficits. The present case illustrates that a historical and rarely used investigation like contrast ventriculogram aids in the diagnosis and management even in the current neurosurgical practice. All patients with late onset syrinx and a previous VP shunt need to be investigated for shunt malfunction before considering syrinx surgery. A simple shunt revision resolves the syrinx in such conditions and avoids more complex procedures like Foramen magnum decompression. Relevant literature has been reviewed; pathophysiology and management options have been discussed.






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