Ventriculoperitoneal shunt obstruction: Difference between revisions
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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 17: | 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 | *Infants with [[bulging fontanelle]]s and suture diastasis | ||
*Irritability | *Irritability | ||
*Change in level of consciousness | *[[AMS|Change in level of consciousness]] | ||
* | *[[Nausea/vomiting]], poor feeding | ||
*Seizure | *[[Seizure]] | ||
*Cushing's triad | *Cushing's triad | ||
| Line 30: | Line 30: | ||
{{VP shunt prob DDX}} | {{VP shunt prob DDX}} | ||
== | ==Evaluation== | ||
*Shunt series | *Shunt series | ||
*CT scan | *[[Head CT|CT]] scan without contrast | ||
*Ventricular tap | *Ventricular tap | ||
*MRI, unless | *[[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 | *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/> | ||
[[Category: | [[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