Overshunting-Related Cervical Myelopathy Causing Progressive Gait Disturbance: A Case Report.

A complication of ventriculoperitoneal (VP) shunting is overdrainage or overshunting of cerebrospinal fluid, which can cause formation of hygroma but in rare cases also cervical myelopathy at a later stage. In this article, we describe a very late complication of VP shunting. We present a 75-year-old man, previously given a VP shunt at the age of 46, who developed a progressive gait disturbance and ataxia of the limbs after 27 years. MRI showed a cervical stenosis and myelopathy as a result of venous engorgement due to chronic overshunting of the VP shunt. Revision of the VP shunt resulted in complete resolution of his neurological symptoms and the cervical myelopathy. Cervical myelopathy due to chronic overshunting is a rare and potentially very late complication of a VP shunt. Our case underlines the importance of awareness of this complication while proper treatment can reverse the associated symptoms fully.

A simple test of choice stepping reaction time for assessing fall risk in people with multiple sclerosis.

Purpose To determine (a) the discriminant validity for established fall risk factors and (b) the predictive validity for falls of a simple test of choice stepping reaction time (CSRT) in people with multiple sclerosis (MS). Method People with MS (n = 210, 21-74y) performed the CSRT, sensorimotor, balance and neuropsychological tests in a single session. They were then followed up for falls using monthly fall diaries for 6 months. Results The CSRT test had excellent discriminant validity with respect to established fall risk factors. Frequent fallers (≥3 falls) performed significantly worse in the CSRT test than non-frequent fallers (0-2 falls). With the odds of suffering frequent falls increasing 69% with each SD increase in CSRT (OR = 1.69, 95% CI: 1.27-2.26, p = <0.001). In regression analysis, CSRT was best explained by sway, time to complete the 9-Hole Peg test, knee extension strength of the weaker leg, proprioception and the time to complete the Trails B test (multiple R2 = 0.449, p < 0.001). Conclusions A simple low tech CSRT test has excellent discriminative and predictive validity in relation to falls in people with MS. This test may prove useful in documenting longitudinal changes in fall risk in relation to MS disease progression and effects of interventions. Implications for rehabilitation Good choice stepping reaction time (CSRT) is required for maintaining balance. A simple low-tech CSRT test has excellent discriminative and predictive validity in relation to falls in people with MS. This test may prove useful documenting longitudinal changes in fall risk in relation to MS disease progression and effects of interventions.

Fatigue, Physical Activity, Quality of Life, and Fall Risk in People with Multiple Sclerosis.

BACKGROUND: Fatigue, inactivity, and falls are major health issues for people with multiple sclerosis (MS). We examined the extent to which fatigue and low walking activity are associated with quality of life and increased fall risk in people with MS. METHODS: People with MS (N = 210, aged 21-74 years) were categorized as having either high or low reported fatigue and walking activity levels and were then followed up for falls using monthly fall diaries for 6 months. RESULTS: A high level of fatigue was significantly associated with higher MS Disease Steps scores, worse balance, high composite physiological (Physiological Profile Assessment) fall risk scores, greater fear of falling, lower World Health Organization Disability Assessment Schedule (WHODAS) quality of life scores, and more prospectively recorded falls. Low walking activity was significantly associated with higher MS Disease Steps scores, reduced proprioception, worse standing and leaning balance, slow stepping, slow gait speed, worse fine motor control, high Physiological Profile Assessment fall risk scores, more fear of falling, and lower WHODAS quality of life scores. CONCLUSIONS: Increased fatigue and low walking activity levels were significantly associated with increased fall risk and lower quality of life in people with MS. Interventions aimed at addressing fatigue and inactivity may have multiple benefits for this group.