Shunt Failure / Infection

FACTS

ISPN shunt guide: The ISPN Shunt Guide - ISPN Guide
CSF shunt valves - x-ray appearance and documents
 

HPI

1) Universal cranial ROS: HA, trauma, falls, nausea/vomiting, speech, visual changes (blurry, double vision)
2) Universal shunt HPI
  • Date of Diagnosis of hydro: congenital vs post-operative vs. post-traumatic vs. post-hemorrhaghic etc.
  • Any history of shunt malfunctions:
    • Radiographic failure: check yourself the preop scans of when patient was revised - do their vents get larger when they fail? Also confirm with the parents although don't expect them to know this or rely solely on it.
    • Clinicaal failure sx: ask parents what it looks like when their shunts fail. Directly ask them - do you feel their shunt is failing? They usually know best.
  • Any history of shunt infections:
    • if so, what bugs, what ABx used?

PHYSICAL EXAM

standard exam
  • evaluate for shunt pumping/refilling
  • evaluate for abnormal eye movements
  • evaluate for resting location of pupils
  • evaluate for leakage of CSF out of incisions
  • evaluate all incisions for erythema/warmth/dehiscence
  • evaluate abdomen (is it tense, distended? constipation can cause shunt "failure")

IMAGING

Shunt series
MRI FAST and Abdominal US for all shunt failure rule outs
  • Overdrainage: evaluate for subdural hematomes or extra-axial fluid collections, slit ventricles
  • Distal infection: Abdominal US to evaluate for psuedocyst (loculated CSF collection in abdomen)
A/P
optho c/s - eval for visual compromise/papilledema and establish baseline prior to treatment