P 1171. Cervical Decompression due to Progressive Cervical Myelopathy in Children after Shunt Treatment of Neonatal E. coli Meningitis

Background: In 2007, Vinchon et al reported on a patient population of nine patients, who underwent shunt placement due to a neonatal Escherichia coli meningitis. As long-term complication, the children suffered from a progressive myelopathy, which was described by the author as “shunt-related progressive myelopathy due to meningeal thickening (SPMMT).” So far, the pathogenesis has not been clarified.

Material and Method: We report on two female patients with SPMMT, whose motor development was initially delayed; however, during the further course, the SPMMT led to a severe progression after an unspecific traumatic fall. Both children showed a high spinal cord injury causing paraplegia after a surgical decompression of the cervical spine.

Table 1

	Patient I	Patient II	Literature (n = 15)
Gender	f	F	f 4, m 11
Meningitis (age at diagnoses)	10 d	13 d	10–86 d
Pathogen	Escherichia coli	Escherichia coli	E. coli (n = 8)
Shunt implantation (age)	1 mo	2 mo	3–6 mo
Motor restriction	Little	None	Yes (n = 9)
Onset because of fall	Yes	Yes	Yes (n = 9)
Trauma (age)	9 y	6 y	7–20 y
Deterioration after operative decompression	Yes	Yes	Yes (n = 11)
Level of spinal cord injury	C2	C2	C0–C7
MRI findings
Dura thickening	Yes	Yes	All
Arachnoiditis	Yes	Yes	Yes (n = 7)
Spinal canal stenosis	Yes	Yes	Yes (n = 7)

Results: Initially, the development of both patients was normal or just somewhat impaired. However, already prior to the fall and the onset of the symptoms: (1) the MRI showed a distinct fourth ventricle and (2) a spinal epidural lipomatosis pronounced in the thoracic region. After a trivial trauma in terms of a fall, a progressive motor deterioration was observed; in the MRI, now a thickening of the spinal dura mater was seen additionally (3) and (4) a swelling of the cervical spinal cord, which (together with the thickened dura mater) resulted in a relative cervical spinal narrowing. As during the further course, the motor function continued to show a clear deterioration, a surgical decompression was performed, which in both children led to a significant and lasting motor (including respiratory) deterioration.

Conclusion: Possibly, in shunted children, a wide fourth ventricle together with an epidural lipomatosis of the thoracic spine are early signs of such deleterious progressions, so that also without any symptoms routine MRI scans (of the brain and of the cervicothoracic spine) might be indicated in such children. In case of a progressive loss of motor skills, a surgical procedure has to be critically discussed.

No conflict of interest has been declared by the author(s).