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1225 - Complication of Subdural Hygroma Post-Lumboperitoneal Shunt Placement in an Acute Rehabilitation Setting

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

NH

Nazia Hossain, MD

Resident Physician
University of Miami Physical Medicine & Rehab
Miami, Florida, United States

Co-Author(s)

JR

Joan C. Rutledge, BS

Medical Student
University of Miami Miller School of Medicine
Miami, Florida, United States
MM

Mariana Maurer Herter, MD

Spinal Cord Injury Fellow
Jackson Memorial Hospital
Miami, Florida, United States
JV

Jose R. Vives, MD

Assistant Professor / Attending Physician
University of Miami Miller School of Medicine / PM&R Department
Miami, Florida, United States

Case Diagnosis: Subdural hygromas are abnormal collections of cerebrospinal fluid (CSF) in the subdural space. They can result from traumatic separation of the dura and arachnoid mater or as a rare complication of ventriculoperitoneal or lumboperitoneal shunts. Patients may present with a variety of non-specific neurological symptoms, including headache, nausea, vomiting, seizures, gait instability, and altered mental status.

Case Description: We report the case of a 70-year-old male with a complex medical history notable for severe thoracic spinal cord arachnoiditis with multiple untethering surgeries and recently progressive thoracic myelopathy with subarachnoid cyst causing cord compression. The patient was admitted to acute inpatient rehabilitation on POD #7 s/p T6-T7 laminectomy for dorsal spinal cord fluid collection and lumboperitoneal shunt placement. During the rehabilitation course, he experienced progressive cognitive and functional decline, including slowed speech, increased fatigue, nausea, vomiting and tremors. A CT brain scan revealed bilateral subdural hygromas, suggestive of shunt overdrainage. The patient was emergently transferred back to the neurosurgery service and underwent a revision syringopleural shunt with placement of a Certas interposition adjustable valve.

Discussions: The pathophysiology of subdural hygroma formation in the setting of shunt overdrainage is poorly understood. A proposed mechanism is the creation of a negative hydrostatic pressure gradient leading to fluid transudation, and tearing of the arachnoid membrane with subsequent CSF extravasation into the subdural space. Asymptomatic subdural hygromas do not necessitate treatment. However, symptomatic cases may require surgical intervention such as burr hole, craniotomy, or shunt placement/revision.

Conclusions: Subdural hygromas are a rare but serious complication following shunt placement that can lead to increasing morbidity and mortality. It is crucial for physiatrists to recognize this rare condition when treating patients with CSF shunts.