VP shunt malfunction is one of the most important things a family needs to understand after their child or relative has had shunt surgery. A working shunt controls hydrocephalus continuously when it stops working, intracranial pressure can rise again, sometimes rapidly. Knowing the warning signs of shunt malfunction and acting on them promptly can prevent serious neurological harm.
The signs of shunt malfunction typically mirror the original presentation of hydrocephalus, because the underlying problem is the same CSF accumulating and pressure rising:
- Headache: New or worsening headache, particularly on waking or when lying flat, in a patient whose headaches had previously been controlled by the shunt
- Nausea and vomiting: Particularly if persistent or projectile
- Lethargy or unusual drowsiness: A child who is harder to wake than usual or an adult who is less alert than their baseline
- Visual changes: Blurred or double vision, or complaints of difficulty seeing
- Behaviour change: Irritability, unusual quietness, or personality change in a child In infants specifically: Bulging fontanelle (the soft spot on top of the head), rapid increase in head circumference, eyes appearing to look downward (sunsetting sign)
- Fever with any of the above: Raises the possibility of shunt infection as well as malfunction and requires urgent assessment
If any of these signs appear, the family should go directly to the emergency department and inform the team that the patient has a VP shunt. Do not wait for a routine clinic appointment. Shunt malfunction can progress rapidly and prompt imaging and neurosurgical review are essential. At Sparsh Hospital, Hennur, Bengaluru, the critical care team is experienced in the assessment and management of post-shunt patients presenting with neurological deterioration.
Written by Dr Deepa Chandran, MBBS (M S Ramaiah Medical College, Bengaluru), DA (Bangalore Medical College), DNB Anaesthesia (Bangalore Baptist Hospital), Fellowship in Ultrasound Guided Regional Anaesthesia (Jubilee Mission Hospital), Fellowship in Pain and Palliative Care, Consultant Neuroanaesthesiologist and Critical Care Specialist, Sparsh Hospital, HBR Layout, Hennur Road, Bengaluru 560043. Phone: 9686911560.
