To the Editor: Koshu et al. (2) have reported the onset of quadriparesis after the insertion of a ventriculoperitoneal shunt for hydrocephalus that was associated with a previously undisclosed cervical neurinoma. This is of great interest to us as we had previously published a series of four cases of “upward spinal coning,” in which impaction of occult spinal tumors became manifest as a myelopathy after hydrocephalus was relieved (1). However, all our patients had intracranial tumors that obstructed the cerebrospinal fluid pathways and, in addition, seeded the spinal subarachnoid space (e.g., medulloblastoma and pineal region tumors). We surmised in our Discussion section that this unusual pathophysiological event would be confined to patients with a malignant third or fourth ventricle tumor. The present report expands the etiological basis of upward spinal coning to include primary intradural tumors of the spine associated with hydrocephalus. This association is well recognized, and it behooves us to consider the possibility of coexisting spinal tumors not only when hydrocephalus is caused by obstruction from a ventricular neoplasm but also when the cause is obscure.