Complex HCP as Sequelae of Severe TBI Case Presentation

2017 ◽  
Vol 2 (4) ◽  
Keyword(s):  
Head Injury ◽  
Cyst Formation ◽  
Female Child ◽  
Normal Activity ◽  
Deep Coma ◽  
Shunt Failure ◽  
Vp Shunt ◽  
Short Period ◽  
Conscious Level ◽  
Ct Brain

Background: Post head injury HCP is not uncommon, its incidence up to 15% among all patients with TBI. The communicating type is more common in TBI than the noncommunicating type. In spite of being treatable sequelae of TBI but it may be complex one. Purpose: to report a case of complex hydrocephalus post sever TBI. Methods: Female child 6ys old presented at ER, after RTA 6months ago. GCS 7∕15, post traumatic epilepsy initial CT; brain edema. She suffering chest problems when she off MV and chest improved, CT brain; show HCP with Rt frontal hygroma, neurologically she has repeated fits and GCS 10∕15, conservative treatment. Not controlled follow up CT; disappeared hygroma and increased HCP. VP shunt inserted followed by immediate improvement. After discharge she get infection, readmitted managed conservatively , fever subside but conscious level not improved and fits not controlled , she developed distal shunt failure and CSF peritoneal pesudocyst. Distal revision was done followed by short period of improvement, then distal shunt failure and reformation of CSF peritoneal pesudocyst occurred. Lastly VA shunt was done followed by stabilization of the case improved conscious level and controlled fits and return normal activity. Results: the patient show neurological recovery from deep coma after proper management of post head injury HCP, and diversion to VA shunt instead VP shunt. Conclusion: Post head injury HCP possible cause of persistent altered neurological status. It's important to differentiating posttraumatic atrophy from posttraumatic hydrocephalus, and this need meticulous estimation of both radiological and clinical findings. Papilledema not always indicator of increased ICP.VA shunt is possible diversion with peritoneal CSF cyst formation.

Severe Head Injury linked to Subsequent Development of Malignant Brain Tumour within a Short Period- A Case Report

2018 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Head Injury ◽  
Brain Tumour ◽  
Severe Head Injury ◽  
Case Reports ◽  
Subsequent Development ◽  
Malignant Brain Tumour ◽  
Tumour Development ◽  
Short Period ◽  
The Brain

There have been a few case reports of head injury leading to brain tumour development in the same region as the brain injury. Here we report a case where the patient suffered a severe head injury with contusion. He recovered clinically with conservative management. Follow up Computed Tomography scan of the brain a month later showed complete resolution of the lesion. He subsequently developed malignant brain tumour in the same region as the original contusion within a very short period of 15 months. Head injury patients need close follow up especially when severe. The link between severity of head injury and malignant brain tumour development needs further evaluation. Role of anti-inflammatory agents for prevention of post traumatic brain tumours needs further exploration.

scholarly journals 332 The diagnostic role of shunt series radiographs (SSR) in children presenting to the children’s emergency department (CED) with suspected ventriculoperitoneal (VP) shunt failure

2020 ◽  
Vol 37 (12) ◽  
pp. 852.3-853
Author(s):  
Angharad Griffiths ◽  
Ikechukwu Okafor ◽  
Thomas Beattie
Keyword(s):  
Clinical Outcome ◽  
Sensitivity And Specificity ◽  
Clinical Information ◽  
Flow Diagram ◽  
List Type ◽  
Shunt Failure ◽  
Vp Shunt ◽  
Wide Range ◽  
Diagnostic Role

Aims/Objectives/BackgroundVP shunts are used to drain CSF from the cranial vault because of a wide range of pathologies and, like any piece of hardware, can fail. Traditionally investigations include SSR and CT. This project examines the role of SSR in evaluating children with suspected VP shunt failure.Primary outcome: Sensitivity and specificity of SSR in children presenting to the CED with concern for shunt failure.Methods/DesignConducted in a single centre, tertiary CED of the national Irish Neurosurgical(NS) referral centre (ED attendance:>50,000 patients/year). 100 sequential SSR requested by the CED were reviewed. Clinical information was extracted from electronic requests. Shunt failure was defined by the need for NS intervention(Revision).Abstract 332 Figure 1Abstract 332 Figure 2Results/ConclusionsSensitivity and specificity is presented in figure 1 (two by two table).100 radiographs performed in 84 children.22% shunts revised (see flow diagram).7 SSR’s were abnormal.85% (n=6) shunts revised. [5 following abnormal CT].Of the normal SSR’s; 16 had abnormal CT and revised.85/100 received CT.64 of 85 CT’s (75%) were normal.□6 of the 64 had focal shunt concern.SSR’s shouldn’t be used in isolation. NPV&PPV, Sensitivity&Specificity is low.SSR’s are beneficial where there’s concern over focal shunt problems (injury/pain/swelling) or following abnormal CT.VP shunt failure is not well investigated with SSR alone.SSR’s could be omitted where there is no focal shunt concern/after normal CT (without impacting clinical outcome) reducing radiation exposure and reduce impact on CED’s.59 SSR’s could have been avoided without adverse clinical outcome.

Ventriculoperitoneal shunt failure causing myelopathy in a patient with bilateral jugular vein occlusion

2007 ◽  
Vol 6 (1) ◽  
pp. 60-63 ◽  
Author(s):  
William E. Humphries ◽  
Peter M. Grossi ◽  
Linda G. Liethe ◽  
Timothy M. George
Keyword(s):  
Spinal Cord ◽  
Ct Angiography ◽  
Jugular Vein ◽  
Cervical Spinal Cord ◽  
Venous Drainage ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Vp Shunt ◽  
Physiological Importance ◽  
Vein Occlusion

✓The authors describe the case of a 36-year-old woman with bilateral internal jugular vein occlusion, hydrocephalus, and Dandy–Walker variant who presented with myelopathy that was ultimately attributed to ventriculoperitoneal (VP) shunt failure. Computed tomography (CT) angiography of the head and neck revealed epidural venous engorgement within the cervical spine, greater that 50% narrowing of the C2–5 spinal canal, and compression of the cervical spinal cord. After successful shunt revision, postoperative CT angiography revealed decreased venous engorgement as well as decompression of the cervical spinal cord, and the patient’s myelopathy improved. This case represents a fascinating clinical presentation of VP shunt failure, highlighting the physiological importance of the external jugular pathways involved in cerebral venous drainage.

scholarly journals Sunken Brain Syndrome

2018 ◽  
pp. 1-3
Keyword(s):  
Computed Tomography ◽  
Cognitive Impairments ◽  
Inpatient Rehabilitation ◽  
Mass Effect ◽  
Middle Cerebral Artery Territory ◽  
Midline Shift ◽  
Vp Shunt ◽  
Tentorial Herniation ◽  
Intravenous Alteplase ◽  
Ct Brain

A 34-year old Chinese lady presented to the hospital in 2013 with acute left sided weakness and was found to have a right middle cerebral artery territory infarct requiring thrombolysis using intravenous alteplase. Her condition deterioriated post thrombolysis as it was complicated by right subdural hematoma, left parieto-occipital hematoma with mass effect and midline shift, for which she required urgent decompressive craniectomy and insertion of ventriculo-peritoneal (VP) shunt for hydrocephalus. Post-operatively she had severe physical and cognitive impairments. She was discharged home with a caregiver after an extensive period of inpatient rehabilitation. Repeated computed tomography (CT) brain between 2014 to 2016 revealed interval resolution of hematoma and stable hydrocephalus. (Figure 1). In late 2017 she was noted to have right gaze preference. Her Glasgow Coma Scale was 15 with no changes to her cognition or behavior. Blood pressure was 110/60 mmHg and pulse rate was 72/minute. Physical examination revealed concavity on the left temporalparietal region of the head. A repeat CT brain showed a concavity of the left craniectomy site suggestive of sunken brain syndrome (SBS) and progressive hydrocephalus from partial shunt blockage without trans-tentorial herniation (Figure 2). Prompt neurosurgical consult was sought and this was quickly followed with an acrylic cranioplasty and revision of VP shunt. She was reviewed post-operatively with resolution of right gaze preference.

scholarly journals Anal Extrusion of Ventriculoperitoneal Shunt: A Case Report and Review of Literature

2021 ◽  
Vol 31 (4) ◽  
pp. 13
Author(s):  
Farhad Bal'afif ◽  
Donny Wisny Wardhana ◽  
Tommy Alfandy Nazwar ◽  
Novia Ayuning Nastiti
Keyword(s):  
Physical Examination ◽  
Ventriculoperitoneal Shunt ◽  
Surgical Procedure ◽  
Rare Complication ◽  
Female Child ◽  
Contributing Factors ◽  
Peritoneal Catheter ◽  
Factors Affecting ◽  
Vp Shunt ◽  
Life Threatening

<p>Ventriculoperitoneal (VP) Shunt is a commonly performed surgical procedure and offers a good result in the treatment of hydrocephalus. In general, 25% of the complication rate of this surgical procedure is abdominal complications. Anal extrusion of a peritoneal catheter is a rare complication ranging from 0.1 to 0.7% of all shunt surgeries. This study presents a rare case of anal extrusion of ventriculoperitoneal shunt in a 1-year-old female child who was asymptomatic. The physical examination revealed swelling and redness along the shunt tract on the retro auricular region, soft abdomen, and no catheter was observed in the anal. This study found several contributing factors affecting the complications in the anal extrusion of a peritoneal catheter, that are thin bowel wall in children and sharp tip and stiff end of VP shunt. The shunt should be disconnected from the abdominal wall, and the lower end should be removed through the rectum by colonoscopy or sigmoidoscopy/proctoscopy or by applying gentle traction on the protruding tube. This study concludes that due to potentially life-threatening consequences and case rarity, thorough anamnesis, physical examination, and objective investigation are needed to determine the appropriate management for anal extrusion of ventriculoperitoneal shunt. </p>

ENDOSCOPIC THIRD VENTRICULOSTOMY (ETV) IS A BETTER ALTERNATIVE FOR VP SHUNT FAILURE IN NON-COMMUNICATING HYDROCEPHALUS

2021 ◽  
pp. 65-67
Author(s):  
Ramesh Tanger ◽  
Dinesh Kumar Barolia ◽  
Arka Chatterjee ◽  
Punit Singh Parihar ◽  
Arun Gupta
Keyword(s):  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Shunt Revision ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Shunt Failure ◽  
Shunt Insertion ◽  
Vp Shunt

CONTEXT: VP Shunt is most commonly used procedure for hydrocephalus but shunt failure is also the common complication in many patients. Endoscopic third ventriculostomy (ETV) is an accepted procedure for the treatment of obstructive hydrocephalus. The aim of our study is to evaluate the success rate AIM AND OBJECTIVE - of ETV in patients of obstructive hydrocephalus formerly treated by ventriculo-peritoneal (VP shunt) shunt. The failure VP shunt was removed before ETV. MATERIALS AND METHOD: This study was conducted between June 2015 and December 2019 in single unit of our department. Twenty one (n=21) patients were enrolled for this study. All patients were admitted with failure of VP shunt. They were known case of non-communicating hydrocephalus previously operated for VP shunt. Six patients were excluded for ETV because CT/MRI show grossly distorted anatomy of ventricles. Endoscopic third ventriculostomy was attempted in 15 patients, but ventriculostomy was done successfully in 10 patients, rests were treated with revision of VP shunt. All patients in this study were radiologically diagnosed RESULTS: case of hydrocephalus due to aqueduct stenosis. They were experienced VP shunt insertion but there were failure of shunt due to any reason. ETV procedures were done successfully in 10 patients. Out of 10 patients one patient needed shunt insertion due ineffective ETV. Shunt revision was done in 11 patients. There was no serious complication during and after ETV procedures. The follow-up period of patients with successful ETV was 6–60 months. This follow-up was uneventful and peaceful for their parents. ETV can be considered as an alternative treatment for the patients w CONCLUSION: ith VP shunt failure with an acceptable success rate of 80%, although long-term follow-up is needed for these patients.

scholarly journals Incidence of and Causes for Ventriculoperitoneal Shunt Failure in Children Younger Than 2 Years: A Systematic Review

2018 ◽  
Vol 80 (01) ◽  
pp. 026-033 ◽  
Author(s):  
Ahmed Abdullah ◽  
Mohamed Alsawy ◽  
Mohamed Soliman ◽  
Ammar Ghaleb ◽  
Reem Elwy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shunt Failure ◽  
Medical Subject Headings ◽  
Vp Shunt ◽  
Related Data ◽  
Pediatric Hydrocephalus ◽  
Age Related ◽  
Common Causes ◽  
Evidence Based Guidelines ◽  
Shunt Obstruction

Objectives Ventriculoperitoneal (VP) shunting is commonly used to treat pediatric hydrocephalus, but failure rates are high. VP shunt failure in children is mostly caused by infection and/or proximal/distal shunt obstruction. However, to our knowledge, no previous reviews have discussed this topic using only clinical studies when age-related data could be obtained. This systematic review aimed at reevaluating what is already known as the most common causes of shunt failure and to determine the incidence and causes of VP shunt failure during the first 2 years of life as a step to establish solid evidence-based guidelines to avoid VP shunt failure in infants. Methods We performed a search using the search terms “Cerebrospinal Fluid Shunts” (Medical Subject Headings [MeSH]) AND failure [All Fields] AND (“humans” [MeSH] AND English [lang] AND “infant” [MeSH]). Only articles that specifically discussed VP shunt complications in children < 2 years were included. Results We found that the most common causes of VP shunt failure in children < 2 years were shunt obstruction and infection, both observed in a range. Conclusion VP shunt failure is very common in infants, mostly resulting from obstruction and infection. Future studies should focus on methods designed to avoid these complications or on alternative treatments for hydrocephalus.

scholarly journals Outcome in Normal Pressure Hydrocephalus after Ventriculoperitoneal Shunt in Tertiary Care Hospital

2021 ◽  
Vol 24 (4) ◽  
pp. 343-349
Author(s):  
Abdul Samad Panezai ◽  
Aurangzeb Kalhoro ◽  
Sher Hassan ◽  
Farrukh Javeed ◽  
Lal Rehman
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Normal Pressure ◽  
Care Hospital ◽  
Vp Shunt ◽  
Excellent Outcome ◽  
Ct Brain ◽  
Biochemical Analyses

Objective:  To determine the outcome of the ventriculoperitoneal shunt in normal pressure hydrocephalus. Material and Methods:  This study was conducted at Jinnah Postgraduate Medical Centre, a tertiary care hospital in Karachi. Patients with idiopathic normal pressure hydrocephalus (NPH) were included. Gender distribution, presentation of symptoms and post-operative outcome based on the Stein Langfitt Scale were assessed. CSF was sent for microbiological and biochemical analyses. All patients were evaluated preoperatively and compared postoperatively during 6 months duration for improvement and any associated complication. Results:  In this study, we had 47 patients, 38 were male and 9 were female. 22 patients presented with dementia, 18 with urinary incontinence, 17 with gait disturbance 17, while 21 had headache based on Stein and Langfitt Scale. The 78.8% patients had an excellent outcome, 17% had a good outcome and 4.2% had poor results. Conclusion:  Ventriculoperitoneal (VP) shunt had promising results selected on history and examination of normal pressure hydrocephalus and improved radiological in Evan’s ratio CT brain scan. Keywords:  Normal Pressure Hydrocephalus (NPH), VP Shunt, Stein and Langfitt Scale.

Using a burr hole valve prevents proximal shunt failure in infants and toddlers

2019 ◽  
Vol 24 (3) ◽  
pp. 315-322
Author(s):  
Chiu-Hao Hsu ◽  
Sheng-Che Chou ◽  
Shih-Hung Yang ◽  
Ming-Chieh Shih ◽  
Meng-Fai Kuo
Keyword(s):  
Protective Factor ◽  
Catheter Insertion ◽  
Burr Hole ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Catheter Migration ◽  
The Mean

OBJECTIVEProximal malfunction is the most common cause of ventriculoperitoneal (VP) shunt failure in young children. In this study, the authors sought to determine factors that affect the migration rate of ventricular catheters in hydrocephalic children who undergo shunt implantation in the first 3 years of life.METHODSThe authors reviewed the medical records and imaging studies of newly diagnosed and treated hydrocephalic children who were younger than 3 years. Patients who received VP shunt insertion through the parieto-occipital route were not included. In total, 78 patients were found who underwent VP shunt insertion between December 2006 and April 2017. Eighteen patients were excluded due to mortality, short follow-up period (< 1 year), and lack of imaging follow-up. The age, sex, etiology of hydrocephalus, initial length of ventricular catheter, valve type (burr hole vs non–burr hole), time to ventricular catheter migration, subsequent revision surgery, and follow-up period were analyzed. The diagnosis of a migrated ventricular catheter was made when serial imaging follow-up showed progressive withdrawal of the catheter tip from the ventricle, with the catheter shorter than 4 mm inside the ventricle, or progressive deviation of the ventricular catheter toward the midline or anterior ventricular wall.RESULTSSixty patients were enrolled. The mean age was 5.1 months (range 1–30 months). The mean follow-up period was 50.9 months (range 13–91 months). Eight patients had ventricular catheter migration, and in 7 of these 8 patients a non–burr hole valve was used. In the nonmigration group, a non–burr hole valve was used in only 6 of the 52 patients. Six of the 8 patients with catheter migration needed second surgeries, which included removal of the shunt due to disconnection in 1 patient. The remaining 2 patients with shunt migration were followed for 91 and 46 months, respectively, without clinical and imaging changes. The authors found that patient age at catheter insertion, ventricular catheter length, and the use of a burr hole valve were protective factors against migration. After ventricular catheter length and patient age at catheter insertion were treated as confounding variables and adjusted with multivariable Weibull proportional hazards regression, the use of a burr hole valve shunt remained a protective factor.CONCLUSIONSThe use of burr hole valves is a protective factor against ventricular catheter migration when the shunt is inserted via a frontal route. The authors suggest the use of a burr hole valve along with a frontal entry point in hydrocephalic children younger than 3 years to maintain long-term shunt function.

Distal ventriculoperitoneal shunt failure caused by silicone allergy

2005 ◽  
Vol 102 (3) ◽  
pp. 536-539 ◽  
Author(s):  
Namath S. Hussain ◽  
Paul P. Wang ◽  
Carol James ◽  
Benjamin S. Carson ◽  
Anthony M. Avellino
Keyword(s):  
Allergic Reaction ◽  
Allergic Reactions ◽  
Shunt Failure ◽  
Valve Mechanism ◽  
Shunt System ◽  
Content Type ◽  
Vp Shunt ◽  
Shunt Tubing ◽  
Fine Print

✓ The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus. Although allergic reactions to the silicone in shunt hardware are very rare, the authors describe a case of silicone allergy causing multiple ventricular shunt revisions. A 24-year-old man, who had undergone multiple VP shunt revisions, presented with shunt malfunction caused by allergic reaction of the tissues surrounding the shunt tubing. The patient's existing silicone-based shunt was replaced with a new polyurethane system, including the proximal and distal catheters as well as the valve mechanism. Contrary to recommendations in previous studies of silicone shunt allergies, long-term immunosuppression was not initiated. The patient was followed up for more than 8 years without recurrence of an allergic reaction to the shunt. This outcome indicates that replacing the original silicone-based shunt system with a polyurethane-based system alone is sufficient in the treatment of a silicone shunt allergy.

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