Rapid Recovery From Cortical Visual Impairment Following Correction of Prolonged Shunt Malfunction in Congenital Hydrocephalus

Connolly, Mary; Jan, James E.; Cochrane, D. Douglas

doi:10.1001/archneur.1991.00530210082028

Cited by 36 publications

(12 citation statements)

References 14 publications

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“…Seventy percent of proven episodes of shunt dysfunction were reported to have positive ophthalmological evidence of raised intracranial pressure [8]. Cortical visual impairment and findings such as permanent visual loss and reversible congruous homonymous hemianopsia have been reported in children with shunt failure [1,6,12]. In their report, Katz et al [11] indicated that shunt failure without ventriculomegaly could be certified by ophthalmic findings.…”

Section: Discussionmentioning

confidence: 99%

Risk of strabismus and ambylopia in children with hydrocephalus

Altıntaş

Etüş

Etus

et al. 2005

Graefe's Arch Clin Exp Ophthalmo

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Section: Discussionmentioning

confidence: 99%

Risk of strabismus and ambylopia in children with hydrocephalus

Altıntaş

Etüş

Etus

et al. 2005

Graefe's Arch Clin Exp Ophthalmo

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“…Classically, patients present with headache, nausea/vomiting and altered mental status [1, 4, 5]. Both transient [6, 8, 9, 10]and permanent [6, 7, 12]visual loss, impaired visual acuity [4]as well as visual field deficits [22]have been described. The phenomenon could be attributed to cortical blindness from posterior cerebral artery occlusion or optic disk edema/pressure.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical presentation of shunt malfunction varies greatly among the population, depending on the age, etiology of hydrocephalus and other factors [4]. Shunt malfunctions have been reported to cause visual compromise [6, 7, 8, 9, 10, 11, 12, 13], seizures [14, 15], fever [16]and midbrain or hypothalamic syndromes [17, 18, 19, 20]. Few previous studies, though, have dealt exclusively with the clinical presentation of pediatric shunt malfunction.…”

Section: Introductionmentioning

confidence: 99%

Unique Clinical Presentation of Pediatric Shunt Malfunction

et al. 1999

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Introduction: A cerebrospinal fluid (CSF) shunt is the primary treatment for most etiologies of hydrocephalus in the pediatric population. Malfunction of the shunt may present with unique symptoms and signs. This retrospective review investigates the presenting signs and symptoms of pediatric patients with shunt malfunction. Clinical Material and Method: One-hundred-and-thirty CSF diversion procedures were performed at two affiliated pediatric hospitals over a 2-year period. Seventy consecutive cases of CSF shunt revision were reviewed. These 70 operations were performed on 65 patients. Their medical records and radiographic studies were reviewed, and supplemented with a telephone interview to obtain a minimum of 3 months follow-up. Results: The 65 patients’ age ranged from 3 months to 16 years. The original etiology of the hydrocephalus was Chiari II malformation in 17, idiopathic in 15 and intraventricular hemorrhage in 10, neoplasm in 8 patients and meningitis in 5 patients. The most frequent presenting symptoms were headache (39 admissions), nausea/vomiting (28) and drowsiness (21). Seven Chiari patients (41%) presented with neck pain, 2 (12%) presented with lower cranial nerve palsy, and 2 (12%) presented with symptomatic syrinx, complaints not reported by non-Chiari patients (p < 0.01, χ² analysis). Four myelodysplastic patients presented with a new-onset or recurrent seizure episode, which was significantly more frequent than in nonmyelodysplastic patients (p < 0.05, χ² analysis). On examination, increased head circumference was noted in 17 patients. Parinaud’s syndrome was noted more prominently in patients with a history of intracranial neoplasm (4 of 8 cases) than in patients with nonneoplastic diseases (2 of 62 cases; p < 0.05, χ² analysis). Other interesting presenting signs were pseudocyst (2), syringomyelia (2), hemiparesis (2) and Parkinson-like rigidity (2). Conclusion: Pediatric shunt malfunction generally presents with headache, nausea/vomiting, altered mental status, increased head circumference and bulging fontanelle. Other less frequent but unique presenting signs and symptoms, such as neck pain, syringomyelia and lower cranial nerve palsy in the myelodysplastic population, and Parinaud’s syndrome in patients with a history of intracranial neoplasm are frequently associated with shunt malfunction and should prompt a radiographic workup.

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“…95 CVI due to hydrocephalus may be transient or episodic, 571 presumably due to a vascular dysfunction mediated by intracranial hypertension. Some patients with compensated hydrocephalus can retain vision and cognitive function despite massive degrees of ventricular enlargement with little residual cortical mantle.…”

Section: Hydrocephalus Ventricular Shunt Failurementioning

confidence: 99%

The Apparently Blind Infant

Brodsky

2009

Pediatric Neuro-Ophthalmology

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Rapid Recovery From Cortical Visual Impairment Following Correction of Prolonged Shunt Malfunction in Congenital Hydrocephalus

Cited by 36 publications

References 14 publications

Risk of strabismus and ambylopia in children with hydrocephalus

Risk of strabismus and ambylopia in children with hydrocephalus

Unique Clinical Presentation of Pediatric Shunt Malfunction

The Apparently Blind Infant

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