Abstract
We describe the case of a 16-year-old boy with idiopathic hydrocephalus, who developed cranial subdural hygromas and subsequent cranial subdural hemorrhage after a shunting procedure. Sciatica and radicular lumbar pain initially seemed to be unrelated to the preceeding implantation of a ventriculoatrial shunt. CT scan revealed a sharply demarcated hyperdensity in the lumbar subdural space with compression of the cauda equina. Differential diagnosis considerations included vascular malformations, vascular tumors, benign tumors of meninges or nerve sheets, ependymoma, lymphoma, and metastases. MR investigation did, in fact, clearly recognize this hyperintense space-occupying lesion as blood in the subdural space which outlined the cauda equina. We believe that the spinal subdural hematoma in our case represented an extension of intracranial subdural haemorrhage fluid into the spinal subdural space.
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Aoki N: Lumboperitoneal shunt: clinical applications, complications, and comparison with ventriculoperitoneal shunt. Neurosurgery 26 (1990) 998–1003
Bills DC, P Blumbergs, JB North: Iatrogenic spinal subdural haematoma. Aust NZJ Surg 61 (1991) 703–706
Blomberg RG: The lumbar subdural extraarachnoid space of humans: an anatomical study using spinaloscopy in autopsy cases. Anesth Analg 66 (1987) 177–180
Bruni P, S Esposito, G Oddi, et al: Subarachnoid hemorrhage from multiple neurofibromas of the cauda equina. Case report. Neurosurg 28 (1991) 910–913
Dammann N, W Schubert: Complications of shunt drainage in pediatric hydrocephalus. Zentralblatt Neurochir 49 (1988) 238–246
Diebler C, O Dulac: Pediatric Neurology and Neuroradiology, Springer Verlag Berlin Heidelberg New York 1987
Epstein MH: Surgical management of hydrocephalus. In: Operative Neurosurgical Techniques Vol. 1, WB Saunders Company 1988
Fody EP, GH Netsky, RE Mrak: Subarachnoid hemorrhage in a case of systemic lupus erythematodes. Arch. Neurol. 37 (1980) 173–174
Grosfeld JI, DR Cooney, J Smith, et al: Intraabdominal complications following ventriculoperitoneal shunt procedures. Pediatrics 54 (1974) 791–796
Haines DE, HL Harkey, O Al Mefty: The “subdural” space: A new look at an outdated concept. Neurosurg 32 (1993) 111–120
Hanakita J, H Suwa, S Nagayasu et al: Clinical features of intradural neurinomas in the cauda equina and around the conus medullaris. Neurochirurgia 35 (1992) 145–149
Herb E, R Schwachenwald, G Nowak et al: Acute bleeding into a filum terminale ependymoma. Neurosurg Rev 13 (1990) 243–245
Jamjoom A, N Ur-Rahman, ZA Jamjoom et al: Unique complications of cerebrospinal fluid shunts in children. A report of two cases. Neurochirurgia 35 (1992) 156–156
Johnson PJ, F Hahn, MC Connell et al: The importance of MRI findings for the diagnosis of nontraumatic lumbar subacute subdural haematomas. Acta Neurochir Wien 113 (1991) 186–188
Kulali A, K von Wild, HP Hobik: Subarachnoid haemorrhage with acute cauda symptom due to spinal tumour. Neurochirurgia 32 (1989) 87–90
Martinez Lage JF, M Poza, JA Esteban: Mechanical complications of the reservoirs and flushing devices in ventricular shunt systems. Br J Neurosurg 6 (1992) 321–325
Modic MT, TJ Masaryk, JS Ross: Magnetic resonance imaging of the spine. Year book Medical Publishers. Chicago London 1989
Mori K. Anomalies of the Central Nervous System, Neuroradiology and Neurosurgery, Thieme Stuttgart New York 1985
Newton TH, DG Potts: Computed tomography of the spine and spinal cord. Clavadel Press, San Anselmo 1983
Patel CD, H Matloud: Vaginal perforation as a complication of VP shunts. J Neurosurg 38 (1973) 761–772
Portnoy HD, PD Croissant: Two unusual complications of a VP shunt drainage. J Neurosurg 40 (1974) 772–773
Schmidt RH, MS Grady, W Cohen et al: Acute cauda equina syndrome from a ruptured aneurysm in the sacral canal. Case report. J Neurosurg 77 (1992) 945–948
Schneider SJ, JS Wisoff, FJ Epstein: Complications of ventriculoperitoneal shunt procedures or hydrocephalus associated with Vein of Galen malformations in childhood. Neurosurg 30 (1992) 706–708
Scotti G, F Filizzolo, G Scialfa et al: Repeated subarachnoid hemorrhages from a cervical meningeoma. J Neurosurg 66 (1987) 779–781
Silver JM, RH Wilkins: Spinal subdural hematoma formation following ventriculoperitoneal shunting for hydrocephalus. Case report. Acta Neurochir Wien 108 (1991) 159–162
van Schayck R, A Niedeggen: Pneumosinus dilatans after prolonged cerebrospinal fluid shunting in young adults with cerebral hemiatrophy. Neurosurg Rev 15 (1992) 217–223
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Wurm, G., Pogady, P., Lungenschmid, K. et al. Subdural hemorrhage of the cauda equina. A rare complication of cerebrospinal fluid shunt. Case report. Neurosurg. Rev. 19, 113–117 (1996). https://doi.org/10.1007/BF00418081
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DOI: https://doi.org/10.1007/BF00418081