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Case Report
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| Ventriculo-peritoneal shunt blockage due to ruptured intracerebral dermoid cyst |
| Ahmad Abu-Omar1, Rupert Price2 |
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1Specialty Registrar in ENT, Department of Otolaryngology, Crosshouse Hospital, Kilmarnock, UK.
2Consultant Neurosurgeon, Department of Neurosurgery, University Hospital of North Staffordshire, Stoke-on-Trent, UK. |
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doi:10.5348/ijcri-2011-09-53-CR-3
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Address correspondence to: Ahmad Abu-Omar Department of Otolaryngology Level 5, Crosshouse Hospital Kilmarnock Road Kilmarnock KA2 0BE United Kingdom Phone: 00447792462582 Fax: 00441563827974 Email: aomar@doctors.org.uk |
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| How to cite this article: |
| Abu-Omar A, Price R. Ventriculo-peritoneal shunt blockage due to ruptured intracerebral dermoid cyst. International Journal of Case Reports and Images 2011;2(9):9-12. |
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Abstract
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Introduction:
Intracranial dermoid cysts are rare congenital lesions that can rupture and disseminate intracranially. We present a unique case of a ruptured dermoid cyst leading to blockage of ventriculo-peritoneal shunts.
Case Report: A 19-year-old female presented with clumsiness, gait disturbance and occipital headache. Examination revealed an ataxic gait, positive Romberg’s sign, lateral gaze nystagmus and hyper-reflexia in all four limbs with bilateral positive Hoffman’s sign. A Magnetic Resonance scan revealed a large, heterogeneous midline cerebellar mass which had evidently ruptured at some point causing diffuse subarachnoid dissemination of fat. The patient underwent an uneventful posterior fossa craniectomy for removal of the cyst and was discharged home. She presented ten weeks later with headaches, ataxia, vomiting and decreased Glasgow Coma Scale. A cranial computed tomography (CT) scan showed ventriculomegaly which was treated with insertion of an external ventricular drain. The patient improved but attempts to clamp the external ventricular drain led to recurrence of symptoms. The patient underwent serial operations for ventriculo-peritoneal shunt insertion, but each time symptoms and Glasgow Coma Scale improved only temporarily. This was postulated to be due to free-floating intraventricular fat repeatedly clogging the shunts. Following its removal there has been no further symptomatic hydrocephalus. Endoscopic aspiration of the intraventricular lipoid material from the frontal horn before the final shunt revision. Conclusion: Fat dissemination from ruptured intracranial dermoid cysts can lead to blockage of ventriculo-peritoneal shunts. We recommend the removal of intraventricular fat from the outset if cerebrospinal fluid diversion is required. | |
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Key Words:
Congenital, Dermoid cyst, Intracranial, Rupture
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Author Contributions:
Ahmad Abu-Omar - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Rupert Price - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission:
The corresponding author is the guarantor of submission. |
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Source of support:
None |
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Conflict of interest:
Authors declare no conflict of interest. |
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Copyright:
© Ahmad Abu-Omar et al. 2011; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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