Cervical Myelopathy Due to Epidural Hematoma at the Cervicomedullary Junction Associated With Ventriculoperitoneal Shunt Overdrainage: A Case Report

We present a case of cervical myelopathy caused by epidural hematoma formation due to chronic cerebrospinal fluid overdrainage. A 55-year-old man who underwent ventriculoperitoneal (V-P) shunt surgery for normal pressure hydrocephalus presented with progressive weakness of both the upper and lower extremities. Magnetic resonance imaging (MRI) revealed compressive myelopathy at the cervicomedullary junction at the C1–C2 level caused by epidural hematoma formation due to intracranial hypotension (IH) caused by a complication of V-P shunt. He underwent decompressive laminectomy and hematoma removal at C1–C2 and replacement of the V-P shunt valve. Follow-up cervical spine MRI showed an improved state of severe central spinal stenosis at the C1–C2 level and an improved state of compression-related cord signal intensity change in the spinal cord. After surgical intervention and intensive rehabilitation, the patient showed clinical improvement. If cervical myelopathy is suspected in patients with a shunt, cord compression due to venous engorgement or hematoma caused by over-shunting and IH should be considered.