Acquired Chiari I malformation following a lumbo-peritoneal shunt – William’s hypothesis revisited

Gupta B, Panigrahi M

Pdf Page Numbers :- 13-15

Gupta B¹ and Panigrahi M^1,*

¹Department of Neurosurgery, Krishna Institute of Medical Sciences, Minister Road, Secunderabad - 500003, AP, India

*Corresponding author: Dr. Manas Panigrahi, M.Ch, (NIMHAS), FACS, Professor and Head of Neurosurgery Department, Krishna Institute of Medical Sciences, Minister Road, Secunderabad - 500003, AP, India, Mobile: +91 9618117118, 9346319808; E-mail: manaspanigrahi@live.com

Received 5 January 2012; Revised 3 February 2013; Accepted 13 February 2013

Citation: Gupta B, Panigrahi M. Acquired Chiari I malformation following a lumbo-peritoneal shunt – William’s hypothesis revisited. J Med Sci Res 2013; 1(1): 13-15. http://dx.doi.org/10.17727/JMSR.2013/1-003

Copyright: © 2013 Gupta B et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Background: Syrinx formation can occur in congenital conditions like Chiari malformation, split cord malformation and also in acquired conditions like trauma, infections and malignancy. Several hypotheses have been put forward to explain the pathogenesis of syrinx formation; William’s pressure dissociation hypothesis is one amongst them. We report a 55 year female who developed Chiari I malformation with syrinx formation, two months after lumbo-peritoneal shunt for communicating hydrocephalus as an evidence to support William’s hypothesis.

Case report: A 55 year old female with no comorbidities was operated two years ago for a left frontotemporal fungal granuloma. She was asymptomatic until two months back when she developed headache and difficulty in walking. CSF analysis was normal and CT head showed communicating hydrocephalous. A Lumbo-peritoneal shunt was performed and patient improved symptomatically following surgery. Two months into the follow up period, she had recurrence of symptoms. MRI brain with CV junction showed communicating hydrocephalus with Chiari I malformation and syrinx formation. Patient underwent a right ventriculo- peritoneal shunt with ligation of lumbo-peritoneal shunt following which she was relieved of her symptoms. A follow up imaging showed resolution of hydrocephalus and obliteration of syrinx.

Conclusion: Acquired Chiari I malformation with syrinx formation after lumbo-peritoneal shunt and resolution of the same after ligation of shunt tube supports William’s hypothesis.

Keywords : Chiari; syrinx; shunt