AccScience Publishing / AN / Online First / DOI: 10.36922/an.4162
CASE REPORT

New onset of ataxic dysarthria with CSF overdrainage syndrome: A case report

Sharareh Tafakori1 Oluwakorede Akele1 Jaya Thiyagarajan1 Kelly Tuchman2 Fraser C. Henderson Sr2,3*
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1 Ross University School of Medicine, University of Maryland Capital Region Medical Center, Largo, MD, United States of America
2 The Metropolitan Neurosurgery Group, LLC, Largo, MD, United States of America
3 Department of Neurosurgery, University of Maryland Capital Region Medical Center, Largo, MD, United States of America
Advanced Neurology, 4162 https://doi.org/10.36922/an.4162
Submitted: 8 July 2024 | Accepted: 20 September 2024 | Published: 4 November 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Cerebrospinal fluid (CSF) overdrainage syndrome occurs when excessive CSF drainage from the cranial cavity results from a spinal CSF leak or overdrainage through a ventriculoperitoneal (VP) or lumboperitoneal (LP) shunt. Symptoms include severe orthostatic headache, worsening with sitting or standing but improving when recumbent. The headache is typically dull, throbbing, and bilateral and may be exacerbated by Valsalva maneuver, coughing, or straining. Additional symptoms can include dizziness, nausea, vomiting, gait disturbances, diplopia, back pain, and seizures. We present a case of overdrainage syndrome following LP shunt placement for idiopathic intracranial hypertension in a 38-year-old woman with Ehlers–Danlos syndrome (EDS). One year post-surgery, she reported worsening headaches and nausea after prolonged upright positioning. Neurological examination revealed cerebellar dysfunction, including dysdiadochokinesia, intention tremor, and ataxic dysarthria. This condition gradually emerged 6 months post-LP shunt placement and was attributed to chronic overdrainage. After 1 day of observation, the patient underwent surgery to clamp the LP shunt outflow, resulting in overnight symptom resolution, including ataxic speech. This case underscores the importance of recognizing ataxic dysarthria in conjunction with low intracranial pressure syndromes, particularly in patients with EDS. It emphasizes the need to be aware of the diverse clinical manifestations of EDS and their relationship to altered CSF pressure syndromes.

Keywords
Idiopathic intracranial hypertension
Ventriculoperitoneal shunt
Lumboperitoneal shunt
Intracranial hypotension
Staccato speech
Aphasia
Ehlers–Danlos syndrome
Funding
None.
Conflict of interest
The authors declare they have no competing interests.
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Advanced Neurology, Electronic ISSN: 2810-9619 Print ISSN: 3060-8589, Published by AccScience Publishing