Abstract
Aims: To evaluate the predictive value of symptoms, signs, and radiographic findings accompanying presumed ventriculoperitoneal (VP) shunt malfunction, by comparing presentation with operative findings and subsequent clinical course.
Methods: Prospective study of all 53 patient referrals to a paediatric neurosurgical centre between April and November 1999 with a diagnosis of presumed shunt malfunction. Referral pattern, presenting symptoms and signs, results of computed tomography (CT) scanning, operative findings, and clinical outcome were recorded. Two patient groups were defined, one with proven shunt block, the other with presumed normal shunt function. Symptomatology, CT scan findings, and the subsequent clinical course for each group were then compared.
Results: Common presenting features were headache, drowsiness, and vomiting. CT scans were performed in all patients. Thirty seven had operatively proven shunt malfunction, of whom 34 had shunt block and three shunt infection; 84% with shunt block had increased ventricle size when compared with previous imaging. For the two patient groups (with and without shunt block), odds ratios with 95% confidence intervals on their presenting symptoms were headache 1.5 (0.27 to 10.9), vomiting 0.9 (0.25 to 3.65), drowsiness 10 (0.69 to 10.7), and fever 0.19 (0.03 to 6.95). Every patient with ventricular enlargement greater than their known baseline had a proven blocked shunt.
Conclusions: Drowsiness is by far the best clinical predictor of VP shunt block. Headache and vomiting were less predictive of acute shunt block in this study. Wherever possible CT scan findings should be interpreted in the context of previous imaging. We would caution that not all cases of proven shunt blockage present with an increase in ventricle size.
Full Text
The Full Text of this article is available as a PDF (80.4 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Casey A. T., Kimmings E. J., Kleinlugtebeld A. D., Taylor W. A., Harkness W. F., Hayward R. D. The long-term outlook for hydrocephalus in childhood. A ten-year cohort study of 155 patients. Pediatr Neurosurg. 1997 Aug;27(2):63–70. doi: 10.1159/000121229. [DOI] [PubMed] [Google Scholar]
- Jamjoom A. H., Wilson P. J. Misleading clinical syndromes of CSF shunt malfunction. Br J Neurosurg. 1988;2(3):391–394. doi: 10.3109/02688698809001011. [DOI] [PubMed] [Google Scholar]
- Kimmings E., Kleinlugtebeld A., Casey A. T., Hayward R. D. Does the child with shunted hydrocephalus require long-term neurosurgical follow-up? Br J Neurosurg. 1996 Feb;10(1):77–81. doi: 10.1080/02688699650040557. [DOI] [PubMed] [Google Scholar]
- Lazareff J. A., Peacock W., Holly L., Ver Halen J., Wong A., Olmstead C. Multiple shunt failures: an analysis of relevant factors. Childs Nerv Syst. 1998 Jun;14(6):271–275. doi: 10.1007/s003810050223. [DOI] [PubMed] [Google Scholar]
- Lee T. T., Uribe J., Ragheb J., Morrison G., Jagid J. R. Unique clinical presentation of pediatric shunt malfunction. Pediatr Neurosurg. 1999 Mar;30(3):122–126. doi: 10.1159/000028778. [DOI] [PubMed] [Google Scholar]
- McCullough D. C., Balzer-Martin L. A. Current prognosis in overt neonatal hydrocephalus. J Neurosurg. 1982 Sep;57(3):378–383. doi: 10.3171/jns.1982.57.3.0378. [DOI] [PubMed] [Google Scholar]
- Molia L., Winterkorn J. M., Schneider S. J. Hemianopic visual field defects in children with intracranial shunts: report of two cases. Neurosurgery. 1996 Sep;39(3):599–603. doi: 10.1097/00006123-199609000-00034. [DOI] [PubMed] [Google Scholar]
- Peacock W. J., Currer T. H. Hydrocephalus in childhood. A study of 440 cases. S Afr Med J. 1984 Sep 1;66(9):323–324. [PubMed] [Google Scholar]
- Rekate H. L. Shunt revision: complications and their prevention. Pediatr Neurosurg. 1991;17(3):155–162. doi: 10.1159/000120587. [DOI] [PubMed] [Google Scholar]
- Renier D., Sainte-Rose C., Pierre-Kahn A., Hirsch J. F. Prenatal hydrocephalus: outcome and prognosis. Childs Nerv Syst. 1988 Aug;4(4):213–222. doi: 10.1007/BF00270917. [DOI] [PubMed] [Google Scholar]
- Watkins L., Hayward R., Andar U., Harkness W. The diagnosis of blocked cerebrospinal fluid shunts: a prospective study of referral to a paediatric neurosurgical unit. Childs Nerv Syst. 1994 Mar;10(2):87–90. doi: 10.1007/BF00302769. [DOI] [PubMed] [Google Scholar]