Ventriculoperitoneal shunt mechanical failure: Difference between revisions
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**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 raised ICP | |||
**Bulging fontanelles in infants | |||
**Irritability, lethargy | |||
**Headache | |||
**Nausea and vomiting, poor feeding | |||
**Seizure | |||
**Cushing's triad | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 16: | Line 25: | ||
==Evaluation== | ==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<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 obstruction]] | |||
*[[Ventriculoperitoneal shunt overdrainage]] | |||
*[[Ventriculoperitoneal shunt infection]] | |||
==External Links== | ==External Links== | ||
Revision as of 16:10, 8 September 2016
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
- 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
- Ventriculoperitoneal shunt obstruction
- Ventriculoperitoneal shunt overdrainage
- Ventriculoperitoneal shunt infection
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.