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 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

Ventriculoperitoneal shunt problems

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.

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