Shu yi lydia au, yuen lei sze, ying hui dina ee, siyang ira sun and shiong wen low.Reversible hydrocephalus from ventriculoperitoneal shunt dysfunction secondary to mri exposure¿a rare cause of functional decline in elderly.Qjm: an international journal of medicine 0(2019).Doi: 10.1093/qjmed/hcz100 case report: a (b)(6) year-old female from singapore presented to the geriatrics clinic for functional decline.She was previously ambulating and managing her activities of daily living (adls) independently.Within a week, she could no longer sit upright on her own and needed full assistance for all her adls except feeding.She became forgetful and could not even recognize her domestic helper.Her background history included diabetes, hyperlipidaemia, well-controlled epilepsy, strokewith residual mild left-sided hemiparesis, dysthymia and hearing impairment.She underwent a right-sided craniotomy for meningioma in 1989.This resection was complicated by hydrocephalus for which a ventriculoperitoneal (vp) shunt was inserted in 1991.Her shunt was magnetic resonance imaging (mri)¿compatible.The physical examination was normal, except for left-sided hemiparesis and severely poor sitting balance.A month prior to this clinic visit, she was admitted to the neurology ward for recurrent falls.A computed tomography (ct) scan of the brain showed her old right-sided craniotomy and stable ventricular size.Mri of the spine was done as she reported numbness over the c4¿c8 dermatomes.The vp shunt was checked before mri exposure.Mri revealed old cervical myelopathy with cord compression at c4/c5 levels and a w edge compression fracture of superior endplate of t12.The neurosurgeons were consulted and recommended conservative management.At discharge, she ambulated independently.Her current functional decline prompted an urgent ct of the brain, which revealed acute severe hydrocephalus.An immediate review by the neurosurgeon found an abnormal setting or performance level of her shunt valve (ps medical strata adjustable pressure valve).Having ruled out other causes and in consultation with the neurosurgeons, the diagnosis of shunt dysfunction secondary to recent mri exposure was clinched.The setting was promptly reset in the clinic.Five days later, her memory and gait markedly improved.A repeat ct of the brain showed ventricular size that had returned to baseline.
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