22 yo upper extremity weakness, hydrocephalus Options

[claudia sanchez]

A 22-year-old college student has experienced progressive weakness in his upper extremities for one year, deteriorating gradually and associated with muscular atrophy in his hands. He was diagnosed as hydrocephalus when he was one year old, and received no treatment. He found his right wrist weakness during hand wrestling. He felt numbness in his forearms with formication this 2 months. Sometime he had palpitation recently.

On clinical examination, thoracic spine is scoliosis, the curves are concave to the right side of the chest. He has vertical nystagmus in left and right gaze, rotational nystagmus when eyeballs is rotated. Bilateral corneal reflexes are obtuse. Uvula tilts to right. Head circumference is 60 cm. There is marked atrophy of the interossei, thenar and hypothenar muscles bilaterally.

MR image shows hydrocephalus, mild herniation of the cerebellar tonsils (no exceed 5mm),there is a long cavity (from C2 to T12) in spinal cord.

What is appropriate therapy for this patient?Suboccipital decompression for Chiari malformation or ventricle-peritoneal shunt for hydrocephalus? or put a drainge tube into cavity? or just wait, no operation?

Best wishes!

Ming Song
Beijing,China

[This message was edited by Greg Foltz MD on 02-27-02 at .]

[Guest]

I recommend suboccipital decompression with dural augmentation only. The syrinx should resolve on its own without any need for direct shunting.

[Akram Khudayberdiev]

I recommend suboccipital decompression with dural augmentation only. The syrinx should resolve on its own without any need for direct shunting