Sterile cerebrospinal fluid ascites, hydrothorax and hydrocele as a complication of ventriculoperitoneal shunting in an elderly patient

2021 ◽  
Vol 14 (7) ◽  
pp. e242593
Author(s):  
Xiancheng Wu ◽  
Michael Sandhu ◽  
Rajat Dhand ◽  
Leen Alkukhun ◽  
Jivan Lamichhane
Keyword(s):  
Elderly Patient ◽  
Cerebrospinal Fluid ◽  
Normal Pressure ◽  
Age Group ◽  
Massive Ascites ◽  
Diagnostic Modality ◽  
Vp Shunt ◽  
Ventriculoperitoneal Shunting ◽  
History Of ◽  
Scrotal Swelling

An 89-year-old man with a history of multiple abdominal surgeries and ventriculoperitoneal (VP) shunt placement for normal pressure hydrocephalus presented for intractable abdominal bloating and scrotal swelling, for which imaging revealed massive ascites, bilateral hydrocele and small bilateral pleural effusions. Cardiac, hepatic and renal workup were insignificant. Culture and cytology of ascitic fluid were negative for infection or malignancy. Aetiology of the ascites as secondary to Cerebrospinal fluid (CSF) from the VP shunt was confirmed via ligation of the shunt. Sterile CSF ascites, hydrothorax and hydrocele are rare complications of VP shunt for hydrocephalus and are mostly presented in paediatric patients. We report the first known case of concurrent CSF ascites, hydrothorax and hydrocele in an elderly patient. We examine the difficulty of shunt replacement as a diagnostic and treatment modality in this age group and propose the use of reversible shunt ligation as a diagnostic modality.

Role of protein content in CSF ascites following ventriculoperitoneal shunting

1982 ◽  
Vol 57 (3) ◽  
pp. 423-425 ◽  
Author(s):  
Andrew B. Adegbite ◽  
Moe Khan
Keyword(s):  
Cerebrospinal Fluid ◽  
Protein Level ◽  
Normal Values ◽  
Massive Ascites ◽  
Content Type ◽  
Vp Shunt ◽  
Ventriculoperitoneal Shunting ◽  
Shunt Procedure ◽  
Fine Print

✓ The case is reported of an 11-year-old girl with a recurrent craniopharyngioma who developed massive ascites following a ventriculoperitoneal (VP) shunt procedure for hydrocephalus, associated with an elevated cerebrospinal fluid (CSF) protein level. The ascites resolved after removal of the shunt. The CSF protein returned to normal levels following excision of the recurrent craniopharyngioma, and ascites did not recur after a second VP shunt was inserted for recurrent hydrocephalus. In this case, elevated CSF protein is believed to have been responsible for ascites developing after VP shunting. There was no recurrence of ascites after the peritoneal cavity was again used for shunting, at which time the protein had returned to normal values. Twelve previous cases of ascites complicating VP shunting are reviewed and the etiology of this condition is discussed.

CEREBROSPINAL FLUID DRAINAGE AND DYNAMICS IN THE DIAGNOSIS OF NORMAL PRESSURE HYDROCEPHALUS

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 919-926 ◽  
Author(s):  
Graeme F. Woodworth ◽  
Matthew J. McGirt ◽  
Michael A. Williams ◽  
Daniele Rigamonti
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Waveform Analysis ◽  
Csf Shunt ◽  
Symptom Improvement ◽  
Wave Characteristics ◽  
Csf Drainage ◽  
Ventriculoperitoneal Shunting ◽  
Csf Shunting

Abstract INTRODUCTION Because of the difficulty in distinguishing idiopathic normal pressure hydrocephalus (INPH) from other neurodegenerative conditions unrelated to cerebrospinal fluid (CSF) dynamics, response to CSF shunting remains highly variable. We examined the utility of CSF drainage and CSF pressure (Pcsf) dynamics in predicting response to CSF shunting for patients with INPH. METHODS Fifty-one consecutive INPH patients underwent continuous lumbar Pcsf monitoring for 48 hours followed by 72 hours of slow CSF drainage before ventriculoperitoneal shunting. Response to CSF drainage and B-wave characteristics were assessed via multivariate proportional-hazards regression analysis. RESULTS Improvement in 1, 2, or all 3 INPH symptoms was observed in 35 (69%), 28 (55%), and 11 (22%) patients, respectively, after CSF shunt implantation by 12 months after surgery. A positive response to CSF drainage was found to be an independent predictor of shunt responsiveness (relative risk, 0.30; 95% confidence interval, 0.09–0.98; P = 0.05). There was no difference in Pcsf wave characteristics between the shunt-responsive and -nonresponsive groups, regardless of whether 1-, 2-, or 3-symptom improvement was used to define response to CSF shunting. CONCLUSION In this study of 51 INPH patients who underwent Pcsf monitoring with waveform analysis and CSF drainage followed by shunt surgery, there was no correlation between specific Pcsf wave characteristics and objective symptomatic improvement after shunt placement. Pcsf monitoring with B-wave analysis contributes little to the diagnostic dilemma with INPH patients. Clinical response to continuous CSF drainage over a 72-hour period suggests a high likelihood of shunt responsiveness.

Lumbar drain trial outcomes of normal pressure hydrocephalus: a single-center experience of 254 patients

2020 ◽  
Vol 132 (1) ◽  
pp. 306-312 ◽  
Author(s):  
Tarek Y. El Ahmadieh ◽  
Eva M. Wu ◽  
Benjamin Kafka ◽  
James P. Caruso ◽  
Om J. Neeley ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Insertion Site ◽  
Normal Pressure ◽  
Csf Leak ◽  
Complication Rates ◽  
Lumbar Drain ◽  
Ventriculoperitoneal Shunting ◽  
History Of ◽  
Subarachnoid Spaces ◽  
The Mean

OBJECTIVEA short-term lumbar drain (LD) trial is commonly used to assess the response of normal pressure hydrocephalus (NPH) patients to CSF diversion. However, it remains unknown whether the predictors of passing an LD trial match the predictors of improvement after ventriculoperitoneal shunting. The aim of this study was to examine outcomes, complication rates, and associations between predictors and outcomes after an LD trial in patients with NPH.METHODSThe authors retrospectively reviewed the records of 254 patients with probable NPH who underwent an LD trial between March 2008 and September 2017. Multivariate regression models were constructed to examine predictors of passing the LD trial. Complications associated with the LD trial procedure were recorded.RESULTSThe mean patient age was 77 years and 56.7% were male. The mean durations of gait disturbance, cognitive decline, and urinary incontinence were 29 months, 32 months, and 28 months, respectively. Of the 254 patients, 30% and 16% reported objective and subjective improvement after the LD trial, respectively. Complications included a sheared LD catheter, meningitis, lumbar epidural abscess, CSF leak at insertion site, transient lower extremity numbness, slurred speech, refractory headaches, and hyponatremia. Multivariate analyses using MAX-R revealed that a prior history of stroke predicted worse outcomes, while disproportionate subarachnoid spaces (uneven enlargement of supratentorial spaces) predicted better outcomes after the LD trial (r2 = 0.12, p < 0.05).CONCLUSIONSThe LD trial is generally safe and well tolerated. The best predictors of passing the LD trial include a negative history of stroke and having disproportionate subarachnoid spaces.

scholarly journals A rare case of ventriculoperitoneal shunt knot causing intestinal obstruction in an adult

2019 ◽  
Vol 6 (2) ◽  
pp. 640
Author(s):  
Mayank Bhasin ◽  
Karamjot Singh Bedi ◽  
Tarun Chaudhary ◽  
Gurvansh S. Sachdeva ◽  
Shantanu Kumar Sahu
Keyword(s):  
Intestinal Obstruction ◽  
Ventriculoperitoneal Shunt ◽  
Rare Complication ◽  
Exploratory Laparotomy ◽  
Vp Shunt ◽  
Primary Surgery ◽  
First Case ◽  
Ventriculoperitoneal Shunting ◽  
History Of ◽  
Low Incidence

Despite high incidence of complications, Ventriculoperitoneal shunting for hydrocephalus is the cornerstone and the most common neurosurgical procedure. Ventriculoperitoneal shunt knot causing intestinal obstruction is an extremely rare complication needing surgical intervention. A 19 years old male with history of VP shunting in infancy for hydrocephalus with no history of any revision surgery presented in emergency with pain abdomen and multiple episodes of vomiting for 2 days. X ray showed dilated bowel loops with a coiled up VP shunt in the abdomen. Exploratory laparotomy showed multiple dilated bowel loops with a loop of VP shunt around ileal segment with dense fibrotic adhesions causing obstruction. Extensive adhesiolysis was done. Procedure underwent uneventful. Patient recovered swiftly in postoperative period and is currently asymptomatic after 6 months of surgery. Improved surgery skills and shunt design have prevented much of the morbidity of VP shunting. Most of the cases reported earlier were paediatric patients with history of repetitive handling of catheter. We believe this to be the first case of intestinal obstruction by a VPS knot in an adult with no history of manipulation after primary surgery. Due to low incidence it is difficult to clinically suspect such an extremely rare complication. Therefore, an awareness of VP shunt related complications in adult is essential.

Predicting Cognitive Improvement in Normal Pressure Hydrocephalus Patients Using Preoperative Neuropsychological Testing and Cerebrospinal Fluid Biomarkers

Neurosurgery ◽  
2019 ◽  
Vol 85 (4) ◽  
pp. E662-E669 ◽  
Author(s):  
Robert A McGovern ◽  
Taylor B Nelp ◽  
Kathleen M Kelly ◽  
Andrew K Chan ◽  
Pietro Mazzoni ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Neuropsychological Test ◽  
Neuropsychological Testing ◽  
Verbal Learning ◽  
Normal Pressure ◽  
Receiver Operating Curve ◽  
Csf Biomarkers ◽  
Cognitive Improvement ◽  
Ventriculoperitoneal Shunting

Abstract BACKGROUND Though it is well known that normal pressure hydrocephalus (NPH) patients can cognitively improve after ventriculoperitoneal shunting (VPS), one of the major dilemmas in NPH is the ability to prospectively predict which patients will improve. OBJECTIVE To prospectively assess preoperative predictors of postshunt cognitive improvement. METHODS This was a prospective observational cohort including 52 consecutive patients with approximately 1-yr follow-up. Patients underwent neuropsychological testing at baseline, postlumbar drainage, and postshunt. Cerebrospinal fluid (CSF) biomarkers and cortical biopsies were also collected to examine their relationship with postshunt cognitive improvement. RESULTS Rey Auditory Verbal Learning Test-L (RAVLT-L) was the only neuropsychological test to demonstrate statistically significant improvement both postlumbar drain and postshunt. Improvement on the RAVLT-L postlumbar drain predicted improvement on the RAVLT-L postshunt. Patients with biopsies demonstrating Aβ+ Tau+ had lower ventricular CSF Aβ42 and higher lumbar CSF pTau compared to Aβ– Tau– patients. A receiver operating curve analysis using lumbar pTau predicted Aβ+ Tau+ biopsy status but was not related to neuropsychological test outcome. CONCLUSION The RAVLT can be a useful preoperative predictor of postoperative cognitive improvement, and thus, we recommend using the RAVLT to evaluate NPH patients. CSF biomarkers could not be related to neuropsychological test outcome. Future research in a larger patient sample will help determine the prospective utility of CSF biomarkers in the evaluation of NPH patients.

scholarly journals Management of ventriculo-gallbladder shunt in the presence of gallstones

2020 ◽  
Vol 13 (6) ◽  
pp. e234775
Author(s):  
Sondus Alraee ◽  
Sahar Alshowmer ◽  
Mohammad Alnamshan ◽  
Moutasem Azzubi
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Health Problem ◽  
Optic Glioma ◽  
Endoscopic Retrograde ◽  
Massive Ascites ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Infancy And Childhood ◽  
Cerebrospinal Fluid Protein

Hydrocephalus is a prevalent health problem that is frequently encountered by paediatric neurosurgeons during infancy and childhood. We report a case of an 11-year-old boy with high cerebrospinal fluid protein hydrocephalus secondary to optic glioma that required a ventriculoperitoneal (VP) shunt. The patient had multiple failures of VP shunt and developed massive ascites. Alternatively, the hydrocephalus was treated by ventriculo-gallbladder (VG) shunt in the presence of sludge which was removed from the gallbladder before placement of the shunt. After VG shunt insertion, the patient expressed signs of infection with elevated liver profile, which emphasised the presence of gallstones. While the shunt was kept in its place without any complications, the gallstones were successfully removed by an endoscopic retrograde cholangiopancreatography. In conclusion, the presence of sludge is not a contraindication for VG shunt placement, and, if the VG shunt was complicated with gallstones, it could be treated without the need for cholecystectomy.

Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage

2002 ◽  
Vol 97 (3) ◽  
pp. 519-524 ◽  
Author(s):  
Vitaly Siomin ◽  
Giuseppe Cinalli ◽  
Andre Grotenhuis ◽  
Aprajay Golash ◽  
Shizuo Oi ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Vp Shunt ◽  
Shunt Placement ◽  
History Of ◽  
Fine Print

Object. In this study the authors evaluate the safety, efficacy, and indications for endoscopic third ventriculostomy (ETV) in patients with a history of subarachnoid hemorrhage or intraventricular hemorrhage (IVH) and/or cerebrospinal fluid (CSF) infection. Methods. The charts of 101 patients from seven international medical centers were retrospectively reviewed; 46 patients had a history of hemorrhage, 42 had a history of CSF infection, and 13 had a history of both disorders. All patients experienced third ventricular hydrocephalus before endoscopy. The success rate for treatment in these three groups was 60.9, 64.3, and 23.1%, respectively. The follow-up period in successfully treated patients ranged from 0.6 to 10 years. Relatively minor complications were observed in 15 patients (14.9%), and there were no deaths. A higher rate of treatment failure was associated with three factors: classification in the combined infection/hemorrhage group, premature birth in the posthemorrhage group, and younger age in the postinfection group. A higher success rate was associated with a history of ventriculoperitoneal (VP) shunt placement before ETV in the posthemorrhage group, even among those who had been born prematurely, who were otherwise more prone to treatment failure. The 13 premature infants who had suffered an IVH and who had undergone VP shunt placement before ETV had a 100% success rate. The procedure was also successful in nine of 10 patients with primary aqueductal stenosis. Conclusions. Patients with obstructive hydrocephalus and a history of either hemorrhage or infection may be good candidates for ETV, with safety and success rates comparable with those in more general series of patients. Patients who have sustained both hemorrhage and infection are poor candidates for ETV, except in selected cases and as a treatment of last resort. In patients who have previously undergone shunt placement posthemorrhage, ETV is highly successful. It is also highly successful in patients with primary aqueductal stenosis, even in those with a history of hemorrhage or CSF infection.

Hereditary Heparin Cofactor II Deficiency and the Risk of Development of Thrombosis

1987 ◽  
Vol 57 (02) ◽  
pp. 196-200 ◽  
Author(s):  
R M Bertina ◽  
I K van der Linden ◽  
L Engesser ◽  
H P Muller ◽  
E J P Brommer
Keyword(s):  
Liver Disease ◽  
Venous Thrombosis ◽  
Healthy Volunteers ◽  
Mean Value ◽  
Age Group ◽  
Normal Range ◽  
Heparin Cofactor Ii ◽  
History Of ◽  
Group 2 ◽  
Hereditary Nature

SummaryHeparin cofactor II (HC II) levels were measured by electroimmunoassay in healthy volunteers, and patients with liver disease, DIC, proteinuria or a history of venous thrombosis. Analysis of the data in 107 healthy volunteers revealed that plasma HC II increases with age (at least between 20 and 50 years). HC II was found to be decreased in most patients with liver disease (mean value: 43%) and only in some patients with DIC. Elevated levels were found in patients with proteinuria (mean value 145%). In 277 patients with a history of unexplained venous thrombosis three patients were identified with a HC II below the lower limit of the normal range (60%). Family studies demonstrated hereditary HC II deficiency in two cases. Among the 9 heterozygotes for HC II deficiency only one patient had a well documented history of unexplained thrombosis. Therefore the question was raised whether heterozygotes for HC II deficiency can also be found among healthy volunteers. When defining a group of individuals suspected of HC II deficiency as those who have a 90% probability that their plasma HC II is below the 95% tolerance limits of the normal distribution in the relevant age group, 2 suspected HC II deficiencies were identified among the healthy volunteers. In one case the hereditary nature of the defect could be established.It is concluded that hereditary HC II deficiency is as prevalent among healthy volunteers as in patients with thrombotic disease. Further it is unlikely that heterozygosity for HC II deficiency in itself is a risk factor for the development of venous thrombosis.

Sign in / Sign up

Export Citation Format

Share Document