Ventriculoperitoneal shunt obstruction: Difference between revisions
(Created page with "==Background== *Most common type of shunt malfunction **Usually occurs at proximal tubing, followed by distal tubing followed by valve chamber *Proximal obstructions usually o...") |
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*Proximal obstructions usually occurs within first years of insertion | *Proximal obstructions usually occurs within first years of insertion | ||
*Distal obstruction usually occurs only with shunts in place for >2yr | *Distal obstruction usually occurs only with shunts in place for >2yr | ||
*60% of children suffer malfunction within lifetime | |||
===Causes=== | ===Causes=== | ||
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**Choroid plexus | **Choroid plexus | ||
**Clot | **Clot | ||
**Infection | **[[VP shunt infections|Infection]] | ||
**Catheter-tip migration | **Catheter-tip migration | ||
**Localized immune response to the tubing | **Localized immune response to the tubing | ||
| Line 16: | Line 17: | ||
**Kinking or disconnection of the tube | **Kinking or disconnection of the tube | ||
**Pseudocyst formation | **Pseudocyst formation | ||
**Infection | **[[VP shunt infections|Infection]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Infants with [[bulging fontanelle]]s and suture diastasis | |||
*Irritability | |||
*[[AMS|Change in level of consciousness]] | |||
*[[Nausea/vomiting]], poor feeding | |||
*[[Seizure]] | |||
*Cushing's triad | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{VP shunt prob DDX}} | |||
== | ==Evaluation== | ||
*Shunt series | |||
*[[Head CT|CT]] scan without contrast | |||
*Ventricular tap | |||
*[[brain MRI|MRI]], unless patient has programmable shunt (Can be recalibrated by Neurosurgery if needed) | |||
*Pumping shunt (institution dependent) - may pull choroid plexus into shunt or cause intraparenchymal bleed | |||
==Management== | ==Management== | ||
*Rapid deterioration and NSGY capability distant, may require shunt tap until pressure < 15 mmHg | |||
*If pressure not relieved by shunt tap, obstruction likely proximal | |||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
*[[Hydrocephalus]] | |||
==External Links== | ==External Links== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Neurology]] | |||
Latest revision as of 16:55, 3 October 2019
Background
- Most common type of shunt malfunction
- Usually occurs at proximal tubing, followed by distal tubing followed by valve chamber
- Proximal obstructions usually occurs within first years of insertion
- Distal obstruction usually occurs only with shunts in place for >2yr
- 60% of children suffer malfunction within lifetime
Causes
- Proximal obstruction
- Tissue debris
- Choroid plexus
- Clot
- Infection
- Catheter-tip migration
- Localized immune response to the tubing
- Distal obstruction
- Kinking or disconnection of the tube
- Pseudocyst formation
- Infection
Clinical Features
- Infants with bulging fontanelles and suture diastasis
- Irritability
- Change in level of consciousness
- 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
- CT scan without contrast
- Ventricular tap
- MRI, unless patient has programmable shunt (Can be recalibrated by Neurosurgery if needed)
- Pumping shunt (institution dependent) - may pull choroid plexus into shunt or cause intraparenchymal bleed
Management
- Rapid deterioration and NSGY capability distant, may require shunt tap until pressure < 15 mmHg
- If pressure not relieved by shunt tap, obstruction likely proximal