Cerebellar Hemorrhage after Multiple Manual Pumping Tests of a Ventriculoperitoneal Shunt: A Case Report

我們提出一位七十三歲的男性病患，因為左側內頸動脈血管瘤破裂合併蜘蛛膜下腔出血，而接受腦動脈瘤夾扼手術，治療後順利康復。術後三個月，因為漸近性智力衰退及步態不穩而診斷出水腦症，患者接受腦室腹腔分流術治療，我們使用的是Medtronic低調節壓的引流管，病患回復情況良好。兩年後，患者因左側天幕上腦梗塞而有右側偏癱及失語症之後遺症。腦血管手術九年後，病患因為泌尿道感染合併敗血症而意識狀態政變（昏迷指數為11分，E3V3M5)，患者的太太誤以為按壓貯液囊引流脊髓液可改善意識狀況而反覆按壓，但反而使病患陷入深度昏迷，腦部斷層掃描顯示腦脊髓液過度引流及雙側小腦蜘蛛膜下腔出血，經過藥物治療後，患者意識慢慢回復，而順利出院。此個案提醒神經外科醫師，對於接受腦室腹腔分流術的水腦症患者，要給病患及其照顧者良好的衛教，避免過度按壓引流管貯液囊而可能發生腦脊髓液過度引流及小腦出血等併發症。

關鍵字

小腦出血；腦脊髓液過度引流；腦室腹腔分流術

並列摘要

A manual pumping test is commonly used to verify the patency of a ventriculoperitoneal (V-P) shunt. Complications occurring after manual pumping of the reservoir are rare. Here, we report a 73-year-old male hydrocephalic patient who had undergone uneventful V-P shunt surgery 9 years ago. He developed a cerebellar hemorrhage after repetitive pressing of the shunt reservoir. The clinical manifestations, characteristic radiologic images, treatment outcome, and possible mechanisms of this late complication are presented. The risk of massive cerebrospinal fluid overdrainage after repetitive manual pumping of the V-P shunt reservoir, which can contribute to the formation of a cerebellar hemorrhage, warrants special attention and hydrocephalic patients and their caregivers should be informed and educated about this potential complication.

並列關鍵字

cerebellar hemorrhage ； cerebrospinal fluid overdrainage ； ventriculoperitoneal shunt

國際替代計量

Cerebellar Hemorrhage after Multiple Manual Pumping Tests of a Ventriculoperitoneal Shunt: A Case Report

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