Cerebellar Hemorrhage After Multiple Manual Pumping Tests of a Ventriculoperitoneal Shunt: A Case Report

Huang, Chih‐Yuan; Hung, Yao-Min; Tai, Shih‐Huang; Lee, E-Jian

doi:10.1016/s1607-551x(09)70037-3

Cited by 5 publications

(3 citation statements)

References 25 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We report a more benign course than that of the one with the lumboperitoneal shunt, which is in line with our belief of the role the gradient direction plays in the pathogenesis of RCH. We are not, however, the first to attribute RCH to a VPS, but in that other reported case, the cause of cerebellar bleeding was the well-intentioned but ill-advised compression of the reservoir over 200 times in 10 minutes by the patient’s relative, with an estimated forced drainage of 120 mL [14]. So, unlike our case, it supports the necessity of significant CSF hypovolemia in the pathophysiology of RCH.…”

Section: Discussionsupporting

confidence: 51%

Remote cerebellar hemorrhage due to ventriculoperitoneal shunt in an infant: a case report

Bokhari

Baeesa

2012

J Med Case Reports

View full text Add to dashboard Cite

IntroductionCerebellar hemorrhage remote from the operative site is an unpredictable and rare complication in neurosurgery, with reported rates of morbidity and mortality in the literature of 8.4% and 7.8%, respectively. The range of procedures associated with remote cerebellar hemorrhage is diverse and includes both supratentorial and spinal procedures that entail significant cerebral spinal fluid loss or resection of supratentorial content. We present here the first documented case of remote cerebellar hemorrhage after controlled supratentorial cerebral spinal fluid drainage by ventriculoperitoneal shunt, and discuss the proposed pathophysiology and treatment.Case presentationWe present the case of a four-month-old Saudi Arabian male baby who presented with progressive symptoms and signs of congenital hydrocephalus. An uneventful ventriculoperitoneal shunting was performed with our patient recovering smoothly in the immediate postoperative period. On the next day, he had frequent episodes of vomiting and became lethargic. An urgent computed tomography scan of his brain revealed mild ventricular decompression and unexpected cerebellar hemorrhage. The infant was put under close observation, with marked spontaneous improvement over 48 hours and complete resolution of the hemorrhage on a follow-up computed tomography brain scan two weeks later. On regular outpatient visits at one, three and twelve months, he had no neurological deficit.ConclusionRemote cerebellar hemorrhage is a complication that remains enigmatic in terms of both the underlying mechanism and clinical behavior. Our case revealed that the risk factors identified in the literature are not sufficient in predicting patients at risk of developing remote cerebellar hemorrhage. Our report also adds to the growing body of evidence challenging the currently accepted hypothesis explaining the pathomechanism of remote cerebellar hemorrhage. It thereby remains an unpredictable hazard that requires further study and increased awareness, as many cases in the literature are incidental findings.

show abstract

Section: Discussionsupporting

confidence: 51%

Remote cerebellar hemorrhage due to ventriculoperitoneal shunt in an infant: a case report

Bokhari

Baeesa

2012

J Med Case Reports

View full text Add to dashboard Cite

show abstract

“…[1][2][3] We never saw any clinical symptoms of relevant hypotension following pumping, 1,6,7,11 or radiological signs of overdrainage or hemorrhage. 12 We still cannot fully exclude such a danger, especially in cases involving very narrow ventricles. Thus we also recommend that the practitioner avoid unnecessary flushing, or at least confine it to a minimum number of strokes.…”

Section: Discussionmentioning

confidence: 99%

An improved reservoir for the flushing test to diagnose shunt insufficiency

Schlosser

Crawack

Miethke

et al. 2016

FOC

View full text Add to dashboard Cite

OBJECTIVE Reservoirs integrated into hydrocephalus shunts are commonly used for the removal of CSF and for intra-ventricular pressure measurement. Pumping with the reservoir to diagnose shunt sufficiency is still a matter of controversy. The authors describe an improved flushing device and its characteristic features in vitro and in vivo. METHODS The flushing reservoir is constructed with a sapphire ball in a cage as a nonresistance valve to also enable the detection of distal occlusions. The most important reservoir parameters were investigated in vitro, simulating total and partial proximal and distal shunt occlusions. Then the expected advantages were assessed in vivo by evaluating the pump test data of 360 implanted reservoirs. The results were compared with those found in the literature. RESULTS The optimization of the technical parameters of the device, such as the high stroke volume in combination with moderate suction force, are obvious advantages compared with other flushing devices. Total occlusion of the ventricular catheter and the valve could be assessed with high certainty. The detection of a total obstruction of the peritoneal catheter or any partial obstruction is also possible, depending on its exact grade and location. CONCLUSIONS Shunt obstructions can be assessed using the pumping test. The reservoir construction presented here provides a clear enhancement of that diagnostic test.

show abstract

“…With regard to adult hydrocephalus, remote intracranial bleeds (most commonly cerebellar hemorrhages) have also been seen following lumboperitoneal shunting, 83 simple lumbar puncture, 9 reduction in the valve pressure of a ventriculoperitoneal shunt, 69 multiple manual pumping of a ventriculoperitoneal shunt valve, 42 and placement of an external ventricular drain. 22 All seem to have CSF loss as a common denominator.…”

mentioning

confidence: 99%

Cerebral venous overdrainage: an under-recognized complication of cerebrospinal fluid diversion

Barami

2016

FOC

View full text Add to dashboard Cite

Understanding the altered physiology following cerebrospinal fluid (CSF) diversion in the setting of adult hydrocephalus is important for optimizing patient care and avoiding complications. There is mounting evidence that the cerebral venous system plays a major role in intracranial pressure (ICP) dynamics especially when one takes into account the effects of postural changes, atmospheric pressure, and gravity on the craniospinal axis as a whole. An evolved mechanism acting at the cortical bridging veins, known as the “Starling resistor,” prevents overdrainage of cranial venous blood with upright positioning. This protective mechanism can become nonfunctional after CSF diversion, which can result in posture-related cerebral venous overdrainage through the cranial venous outflow tracts, leading to pathological states. This review article summarizes the relevant anatomical and physiological bases of the relationship between the craniospinal venous and CSF compartments and surveys complications that may be explained by the cerebral venous overdrainage phenomenon. It is hoped that this article adds a new dimension to our therapeutic methods, stimulates further research into this field, and ultimately improves our care of these patients.

show abstract

Cerebellar Hemorrhage After Multiple Manual Pumping Tests of a Ventriculoperitoneal Shunt: A Case Report

Cited by 5 publications

References 25 publications

Remote cerebellar hemorrhage due to ventriculoperitoneal shunt in an infant: a case report

Remote cerebellar hemorrhage due to ventriculoperitoneal shunt in an infant: a case report

An improved reservoir for the flushing test to diagnose shunt insufficiency

Cerebral venous overdrainage: an under-recognized complication of cerebrospinal fluid diversion

Contact Info

Product

Resources

About