Ventriculoperitoneal shunt obstruction

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

Disposition

See Also

Hydrocephalus

External Links

References

This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.