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Advanced Neurology

CASE REPORT
New onset of ataxic dysarthria with CSF

overdrainage syndrome: A case report

Sharareh Tafakori , Oluwakorede Akele , Jaya Thiyagarajan , Kelly Tuchman 2 ,
1
1
1
and Fraser C. Henderson Sr *
2,3
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

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,
*Corresponding author: back pain, and seizures. We present a case of overdrainage syndrome following
Fraser C. Henderson Sr
(henderson@fraserhendersonmd. LP shunt placement for idiopathic intracranial hypertension in a 38-year-old
com) woman with Ehlers–Danlos syndrome (EDS). One year post-surgery, she reported
Citation: Tafakori S, Akele O, worsening headaches and nausea after prolonged upright positioning. Neurological
Thiyagarajan J, Tuchman K, examination revealed cerebellar dysfunction, including dysdiadochokinesia,
Henderson FC Sr. New onset intention tremor, and ataxic dysarthria. This condition gradually emerged 6 months
of ataxic dysarthria with CSF
overdrainage syndrome: A case post-LP shunt placement and was attributed to chronic overdrainage. After 1 day of
report. Adv Neurol. 2025;4(1):105-109. observation, the patient underwent surgery to clamp the LP shunt outflow, resulting
doi: 10.36922/an.4162 in overnight symptom resolution, including ataxic speech. This case underscores
Received: July 8, 2024 the importance of recognizing ataxic dysarthria in conjunction with low intracranial
pressure syndromes, particularly in patients with EDS. It emphasizes the need to be
Revised: August 9, 2024
aware of the diverse clinical manifestations of EDS and their relationship to altered
Accepted: September 20, 2024 CSF pressure syndromes.
Published Online: November 4,
2024
Keywords: Idiopathic intracranial hypertension; Ventriculoperitoneal shunt;
Copyright: © 2024 Author(s). Lumboperitoneal shunt; Intracranial hypotension; Staccato speech; Aphasia;
This is an Open-Access article
distributed under the terms of the Ehlers–Danlos syndrome
Creative Commons Attribution
License, permitting distribution,
and reproduction in any medium,
provided the original work is
properly cited. 1. Introduction
Publisher’s Note: AccScience Idiopathic intracranial hypertension (IIH) is characterized by elevated cerebrospinal
Publishing remains neutral with fluid (CSF) pressure of unknown cause. Symptoms include headaches, nausea, vomiting,
regard to jurisdictional claims in
published maps and institutional brain fog, visual changes, memory and concentration problems, and neck pain, with
1,2
affiliations. photopsia linked to postural changes. IIH is diagnosed through a lumbar puncture,

Volume 4 Issue 1 (2025) 105 doi: 10.36922/an.4162