Ventriculoperitoneal shunt mechanical failure
Background
Causes
- Fracture of tubing
- Occurs many years after shunt placement in distal tubing
- May present with mild symptoms of increased ICP and local symptoms of pain, erythema, edema
- Disconnection
- Occurs shortly after insertion
- Migration
- Presents as shunt failure
- Misplacement
- Usually manifests postoperatively
Clinical Features
- Shunt fractures may present with localized symptoms over the area (pain, erythema, fluid at skin)
- Features of elevated ICP
- Bulging fontanelles in infants
- Irritability, lethargy
- Headache
- Nausea/vomiting, poor feeding
- Seizure
- Cushing's triad
Differential Diagnosis
Ventriculoperitoneal shunt problems
- Ventriculoperitoneal shunt obstruction
- Ventriculoperitoneal shunt overdrainage (Slit Ventricle Syndrome)
- Ventriculoperitoneal shunt infection
- Ventriculoperitoneal shunt mechanical failure
Evaluation
- Shunt series (AP and lateral x=rays of skull, AP x-rays of chest and abdomen)
- Consider CT head
- 24% of patients with documented shunt malfunction may show no radiologic evidence of the malfunction on plain films or CT[1]
Management
- Neurosurgery consult
- If critically high ICP and no neurosurgeon available, may need to tap shunt as temporizing measure
Disposition
See Also
External Links
References
- ↑ Kim TY, Stewart G: Signs and symptoms of cerebrospinal fluid shunt malfunction in the pediatric emergency department. Pediatr Emerg Care. 2006; 22: 1.