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.
