Radiological placement is consistently more reliable than surgical placement. There are fewer placement complications and fewer catheter infections overall.
A 35-year-old woman presented with a 3 month history of postural unsteadiness. She complained of worsening headaches, with blurred vision for 1 week, accompanied by nausea and vomiting. On examination she was found to have bilateral papilloedema, with slight slowness of mentation but no other feature.
Axial computed tomography (CT) (Fig. 1) showed gross dilatation of the lateral ventricles, with a collapsed third ventricle, consistent with the presence of obstruction to cerebrospinal fluid (CSF) flow at the foramina of Munro. No mass was seen.
A ventriculo-peritoneal shunt was inserted into the right lateral ventricle, with relief of symptoms. A repeat CT at 4 days after shunting showed collapse of the right lateral ventricle, with a considerable reduction in the size of the left (Fig. 2). Cerebral angiography was performed and was normal.
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