Syringomyelia Regression after Shunting of a Trapped Fourth Ventricle
A 28-year-old female was admitted in our department because of a large right-sided intracerebral hemorrhage as a result of a ruptured arteriovenous malformation. She underwent neurosurgical and endovascular treatment. Due to a post hemorrhagic hydrocephalus external ventricular drain was performed. During the intensive care treatment she unfortunately developed meningitis. After antibiotic treatment, the meningitis was cured and a ventriculo peritoneal shunt was performed. However, the follow up imaging, revealed an isolated enlarged fourth ventricle despite shunting of the lateral ventricles. Therefore a shunting of the fourth ventricle has been done as well. Nearly 22 months later the patient presented again with secondary walking and coordination impairment.\nNeurological examination showed increasing ataxia and eye movement disorder beside the known left-sided hemiparesis. Cranial computed tomography (CT) demonstrated remarkable dilation of fourth ventricle indicating a shunt dysfunction. Furthermore syringomyelia without tonsil herniation has occurred, which was identified through cervical magnetic resonance imaging (MRI) extending from C2 to C7. The complete replacement of the dysfunctional shunt system was immediately performed. Postoperatively, the syringomyelia resolved within 6 months and the associated neurological deficits improved as well. An entire resolution of the trapped fourth ventricle was confirmed on CT scan ().