Ventriculoperitoneal shunt mechanical failure: Difference between revisions
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*Fracture of tubing | *Fracture of tubing | ||
**Occurs many years after shunt placement in distal tubing | **Occurs many years after shunt placement in distal tubing | ||
**May present | **May present with mild symptoms of increased ICP and local symptoms of pain, erythema, edema | ||
*Disconnection | *Disconnection | ||
**Occurs shortly after insertion | **Occurs shortly after insertion | ||
*Migration | *Migration | ||
**Presents as shunt failure | |||
*Misplacement | *Misplacement | ||
**Usually manifests postoperatively | **Usually manifests postoperatively | ||
==Clinical Features== | ==Clinical Features== | ||
*Shunt fractures may present with localized symptoms over the area (pain, erythema, fluid at skin) | |||
*Features of [[elevated ICP]] | |||
**[[Bulging fontanelle]]s in infants | |||
**Irritability, [[lethargy]] | |||
**[[Headache]] | |||
**[[Nausea/vomiting]], poor feeding | |||
**[[Seizure]] | |||
**Cushing's triad | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{VP shunt prob DDX}} | {{VP shunt prob DDX}} | ||
== | ==Evaluation== | ||
*Shunt series (AP and lateral x=rays of skull, AP x-rays of [[CXR|chest]] and [[KUB|abdomen]]) | |||
*Consider [[CT head]] | |||
*24% of patients with documented shunt malfunction may show no radiologic evidence of the malfunction on plain films or CT<ref>Kim TY, Stewart G: Signs and symptoms of cerebrospinal fluid shunt malfunction in the pediatric emergency department. Pediatr Emerg Care. 2006; 22: 1.</ref> | |||
==Management== | ==Management== | ||
*Neurosurgery consult | |||
**If critically high ICP and no neurosurgeon available, may need to tap shunt as temporizing measure | |||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
*[[Ventriculoperitoneal shunt problems]] | |||
==External Links== | ==External Links== | ||
| Line 27: | Line 42: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Neurology]] | |||
Latest revision as of 16:54, 3 October 2019
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.