# VP shunt complications - blockage - proximal or distal - cellular debris or granulation tissue most common causes - drowsiness is best predictor of shunt blockage - headache - nausea and vomiting less specific - bradycardia - ataxia - seizures - papilloedema is rare - mgmt: forced pumping of shunt reservoir may help; shunt revision may be required - reservoir puncture in emergency (always d/w NSx first) - shunt infection - s epidermidis, s aureus most common - rare > 1 year post surgery - nausea, vomiting, HA, lethargy - +/- meningeal signs - erythema over shunt device - fever in 40% - 30% have WCC > 20,000; 25% have WCC <10,000 - CSF may be normal in early stages - USS abdomen: pseudocyst around shunt tubing pmplies infection - mgmt: sysytemic and intraventricular abx somewhat successful; vanc and ceftriaxone - removal and immediate replacement better success - shunt nephritis - complication of ventriculo-atrial shunts - over-drainage - low pressure syndromes - headaches worse on standing, resolving when lying down - ICH a risk - subdural haematomas - usually in adults with normal pressure hydrocephalus - abdominal complications - visceral perforation - peritonitis - CSF pseudo-cysts | Proximal obstruction | distal obstruction | | ----------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------- | | - infection<br>- debris<br>- fibrosis<br>- catheter migration into parenchyma | - kinking<br>- infection<br>- fracture<br>- migration of catheter<br>- pseduocyst/adhesions | # investigations - palpate reservoir chamber and compress - difficulty compressing → proximal obstruction - slow refil > 3-5 sec indicates proximal obstruciton - XR VP shunt series: fracture, migration, disconnection - CT - increase in ventricular size: obstruction - slit-like ventricles: over-drainage ## lumbar puncture LP can be done in pt with shunt, but some pts get isolated 4th ventricle hydrocephalus. drainage of 4th ventricle may be blocked while 3rd and laterals drain; pressure difference developps btwn 4th and SAH space--> may result in posterior fossa herniation. therefore, always d/w Nsx prior to doing an LP in a patient with a shunt VP shunt complication # Related Questions ## headache - [ ] 10Q: [VP Shunt Complication](x-devonthink-item://7FCD3940-4BB4-45FE-86A6-E5707E82D5B5?page=28) -- [Answer](x-devonthink-item://3263A68A-96A6-43EC-985B-43260C3509BF?page=9) ## hydrocephalus - [ ] 11Q: [Confused patient with VP shunt](x-devonthink-item://4BE7EDE1-1843-4BA0-B8D2-0DCEF50784D4?page=1) -- [Answer](x-devonthink-item://15F8F701-8EC8-4F9A-8DEC-5220C8561C8A?page=1) ## vp shunt - [ ] 41Q: [Ventricular Shunt Dysfunction](x-devonthink-item://87BC05C2-0A6B-436D-B51A-75E14AA5EA7E?page=5) -- [Answer](x-devonthink-item://98D17FA0-225B-4E94-B21C-4E36D5C76A7C?page=56) -- [prop](x-devonthink-item://093F49C6-2E32-460E-9C00-3E9F15CD417E?page=24) ## vp shunt complication - [x] DUPLICATE Q: [Confused patient with VP shunt](x-devonthink-item://4BE7EDE1-1843-4BA0-B8D2-0DCEF50784D4?page=1) -- [Answer](x-devonthink-item://15F8F701-8EC8-4F9A-8DEC-5220C8561C8A?page=1) - [x] DUPLICATE Q: [VP Shunt Complication](x-devonthink-item://7FCD3940-4BB4-45FE-86A6-E5707E82D5B5?page=28) -- [Answer](x-devonthink-item://3263A68A-96A6-43EC-985B-43260C3509BF?page=9)