Barnes et al identified clinical indicators associated with blockage of a ventriculoperitoneal shunt in a child with hydrocephalus. Early diagnosis and treatment is important since delay can result in permanent sequelae. The authors are from Great Ormond Street Hospital for Children in London.


Classical symptoms:

(1) drowsiness: This is an important symptom for shunt blockage alone or in combination with other findings.

(2) vomiting

(3) headache


Atypical symptoms:

(1) seizures

(2) abdominal pseudocyst

(3) syringomyelia

(4) cranial nerve palsy

(5) hemiparesis

(6) Parkinson-like rigidity

(7) visual failure

(8) developmental standstill


Imaging studies - A CT scan should be performed after placement of the shunt to give a baseline for comparison:

(1) An increase in ventricle size is highly suggestive of shunt blockage.

(2) The absence of an increase (no change) does not exclude shunt blockage.


Other features:

(1) A history of similar findings or the family’s experience with in a previous shunt block episode.

(2) The presence of a VPS without an alternative explanation for symptoms.


To read more or access our algorithms and calculators, please log in or register.