一名40多岁的女性患者有几个月的步态不稳定史,并拖着左腿。她有先天性脑积水的背景,用心室心房分流术治疗.在检查中,她的语气增强,下肢反应活跃,霍夫曼体征呈阳性。计算机断层扫描(CT)扫描和分流系列X射线识别出分流后继发的脑积水。作为表现症状的检查的一部分,还对她的颈椎进行了磁共振成像(MRI),并证明了与退行性颈椎病(DCM)兼容的特征。患者随后进行了分流翻修。手术后,她的步行和手功能在几周内恶化。因此,她接受了颈椎前路减压和DCM融合术,部分改善了她的症状.一系列事件表明分流手术可能导致DCM恶化。可能的解释包括与插管和全身麻醉期间颈部延伸或灌注不足有关的脊髓损伤,或在恢复有效的脑脊液分流后失去脑脊液缓冲。外科医生应警惕这种可能性,并在需要时为DCM提供及时的手术干预。
A female patient in her early 40s presented with a several-month history of gait unsteadiness and dragging her left leg. She had a background of congenital hydrocephalus, treated with a ventriculoatrial shunt. On examination, she had increased tone and brisk reflexes in the lower limbs and a positive Hoffmann sign. A computed tomography (CT) scan and shunt series x-rays identified hydrocephalus secondary to a disconnected shunt. Magnetic resonance imaging (MRI) of her cervical spine was also performed as part of the workup for her presenting symptoms and demonstrated features compatible with degenerative cervical myelopathy (DCM). The patient subsequently underwent a shunt revision. Following the operation, her walking and hand function deteriorated over a period of several weeks. She consequently underwent an anterior cervical decompression and fusion for DCM, which partially improved her symptoms. The sequence of events suggests that the shunt surgery may have precipitated a worsening of the DCM. Possible explanations include spinal cord injury related to neck extension or hypoperfusion during intubation and general anesthesia or the loss of cerebrospinal fluid cushioning following the reinstitution of effective cerebrospinal fluid shunting. Surgeons should be alert to this possibility and offer prompt surgical intervention for DCM if required.