Odd presentation of shunt malfunction: a case series and review of literature

Abstract

Objective Children with previous ventriculoperitoneal shunt (VPS) insertion may refer to the hospital with various clinical complaints. Shunt malfunction is frequently diagnosed in these children necessitating shunt revision. Although increased head circumference, setting sun eye in younger children and headache, nausea/ vomiting, loss of consciousness, visual disturbance, and so on are common clinical manifestations of shunt malfunction, some patients may present with odd or unusual presentation. Here, we present a series of patients with previous shunt insertions who presented with odd and unexpected clinical manifestations. Methods Eight children with shunt malfunction were enrolled in this series. The age, sex, age of shunting, etiology of hydrocephalus and management, post-shunt insertion symptoms/sign, revision surgery, outcome and follow-up were evaluated. Results Patients were aged from 1 to 13 years (mean, 6.38 years). There were 5 males and 3 females. The odd presentation associated with shunt malfunction included facial palsy in three children, ptosis in 3 children, and torticollis and dystonia in 2 children. All patients underwent shunt revision except for one patient in whom a new shunt was inserted. Follow-up showed improved clinical presentation in all patients. Conclusion In this series, we reported eight patients with unusual signs and symptoms following shunt malfunction that were successfully diagnosed and managed.