Multiple anomalies with scoliosis – a case study

History

A 25-year-old woman presents with severe neck and back pain. The pain was most severe in the cervical area. PMH: She has iron deficiencey anemia. She had a vaginal birth with normal gestation. Social: She graduated from high school and she is a housewife in social anamnesis.

Physical examination

Right eye

Limited to lateral vision, neurologic consultation confirmed loss of right eye vision.

Spine

Scoliosis at the dorsal and lumbar region. After radiologic imaging of full spine, several deformities were found in the all parts of spinal column. The cevical magnetic resonance imaging (MRI) confirmed herniation from foramen magnum with cervical scoliosis.

Neuropsychological testing was consistent with attention deficit and very mild cognitive impairment. Language and praxis functions seemed to be preserved.

Brain

Cranial computed tomography and MRI revealed a severe ventriculomegaly compressing the brain cortex but sparing the cerebellum and the brainstem. Ventriculoperitoneal shunting was recommeded by neurosurgery.

Discussion

Long-standing overt ventriculomegaly in adults is a clinical entity characterized by chronic hydrocephalus. The onset of this condition occurs in infancy with a slow evolution and onset of clinical symptoms during adulthood. Limited case reports exists which describe this condition of severe hydrocephalus with the relatively spared neurological functioning and cognitive aspects. This case report demonstrates in vivo the level of adaptation to which human brain can reach under chronic mechanic stress conditions. Scoliosis may present with other anomalies.