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 raised ICP
    • Bulging fontanelles in infants
    • Irritability, lethargy
    • Headache
    • Nausea and vomiting, poor feeding
    • Seizure
    • Cushing's triad

Differential Diagnosis

Ventriculoperitoneal shunt problems

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

  1. Kim TY, Stewart G: Signs and symptoms of cerebrospinal fluid shunt malfunction in the pediatric emergency department. Pediatr Emerg Care. 2006; 22: 1.