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Chronic overdrainage syndrome: pathophysiological insights based on ICP analysis: a case-based review

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Abstract

Introduction

Chronic overdrainage affects shunted patients producing a variety of symptoms that may be misdiagnosed. The best known symptoms are so-called shunt-related headaches. There is mounting evidence that changes in cerebrospinal venous system dynamics are a key factor to the pathophysiology of chronic overdrainage syndrome.

Clinical presentation

We report the case of a 29-year-old woman with a shunt since the postnatal period suffering from chronic but the most severe intermittent headache attacks, despite an open shunt and with unchanged ventricular width during attacks. Intracranial pressure (ICP) recordings were performed during headache attacks and thereafter.

Diagnosis and managment

Massively increased ICPs, a continuous B wave “storm,” and severely compromised intracranial compliance despite an open shunt were found, a scenario that was always self-limiting with the resolution of symptoms after several hours. When mobilized to the upright position, her ICPs dropped to − 17 mm Hg, proving shunt overdrainage.

Outcome and conclusions

Symptomatology can only be explained by sudden venous entrapment following chronic venous distention as a result of chronic overdrainage. Subsequent therapeutic management with an overdrainage preventing shunt and satisfying clinical outcome with complete ceasing of headache attacks adds insight into the pathophysiology of chronic overdrainage syndrome.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Department of Neurosurgery, Eberhard Karls University Hospital of Tübingen, Tübingen, Germany

    Laura V. Sainz, Konstantin Hockel & Martin U. Schuhmann

  2. Department of Neurosurgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

    Laura V. Sainz

Authors
  1. Laura V. Sainz
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  2. Konstantin Hockel
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  3. Martin U. Schuhmann
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Correspondence to Laura V. Sainz.

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Sainz, L.V., Hockel, K. & Schuhmann, M.U. Chronic overdrainage syndrome: pathophysiological insights based on ICP analysis: a case-based review. Childs Nerv Syst 34, 401–408 (2018). https://doi.org/10.1007/s00381-017-3650-4

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  • DOI: https://doi.org/10.1007/s00381-017-3650-4

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