Pediatric emergency medicine trisk 4013 4013

SHUNT FAILURE
Goals of Treatment
Accurate identification of the pathology of a child in distress with a shunt
versus other etiology.
CLINICAL PEARLS AND PITFALLS
Clinicians depend heavily on radiographic imaging to evaluate for
shunt malfunction.
The diagnosis may be challenging for even the most experienced
clinician, especially in nonverbal patients.
Unfortunately, shunt malfunction is one of the most common clinical
problems in pediatric neurosurgery. Children with hydrocephalus, and a
CSF shunt, often have significant neurologic abnormalities and
developmental delays. Symptoms are nonspecific making shunt obstruction
a routine consideration in this patient population. Moreover, the neurologic
examination may be limited and unreliable in these patients.

Clinical Considerations
Clinical Recognition. Shunt malfunction can manifest with a multitude of
acute or chronic signs and symptoms ( Table 122.1 ). The most notable
signs and symptoms of shunt failure are nausea and vomiting (positive
predictive value 79%), irritability (positive predictive value 78%),
decreased level of consciousness (positive predictive value 100%), and a
bulging fontanel (positive predictive value 92%).