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A 4 year old with ventriculoperitoneal shunt revision 1 month ago, presents with headache and vomiting and increased sleepiness according to mom. The patient is well appearing and nontoxic, tolerating po’s in the ED, and has a normal funduscopic and neurologic exam. He got acetaminophen 2 hours ago and has no headache currently.
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March 20, 2018 at 11:31 pm
The answer is D. Despite current lack of symptoms, the presentation is concerning for shunt malfunction, which occurs more commonly in the first months to one year after a new shunt is placed. CT scan is the mainstay for diagnosis, but a shunt series should also be performed to look for shunt breakage or discontinuity. While rapid MRI has been studied and found non-inferior to CT, undergoing the risks of sedation for regular MRI likely do not represent optimal management. For more info: http://www.emdocs.net/complications-csf-shunts-ed-presentations-evaluation-management/
March 23, 2018 at 8:21 am
Great question…. how do you feel about a HASTE protocol MRI. No-sedation that just looks at ventricle size without that nasty radiation? Of course as a night doc i can never get this done and CT is my only option but during the day it is something that my hospital will often do.
Where is the Shunt Tap option? Super easy todo! (make sure you have Nsurg okay first! Just get out a butterfly, betadine and LP tray for the tubes. Can also help with dx (and temporary relief) of shunt obstruction depending on the pressures and where the obstruction is located.