Cerebrospinal Fluid Eosinophilia and Sterile Shunt Malfunction

Traynelis, Vincent C.; Powell, R G; Koss, William; Schochet, Sydney S.; Kaufman, Howard H.

doi:10.1227/00006123-198811000-00019

Cited by 30 publications

(9 citation statements)

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“…This could be a reflection of a proinflammatory state which is only exacerbated by the trauma incurred with each ventricular catheter revision and has led some to advocate that ventricular catheter tracts associated with recurrent failures should, if anatomically possible, be abandoned in favor of virgin tracts (contralateral side, anterior vs. posterior approach). Repeated, short-interval, ventricular catheter obstruction should also raise suspicion for an allergic response, a diagnosis strongly supported by CSF eosinophilia in the context of sterile cultures [67, 68]. Although the PDMS catheter material is the most commonly implicated allergen [65, 69], some have even posited that the ethylene oxide used to sterilize many commercialized shunts may incite an immune response [70] .…”

Section: Obstructionmentioning

confidence: 99%

Cerebrospinal Fluid Shunting Complications in Children

Hanak

Bonow

Harris³

et al. 2017

Pediatr Neurosurg

176

110

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Although cerebrospinal fluid (CSF) shunt placement is the most common procedure performed by pediatric neurosurgeons, shunts remain among the most failure-prone life-sustaining medical devices implanted in modern medical practice. This article provides an overview of the mechanisms of CSF shunt failure for the 3 most commonly employed definitive CSF shunts in the practice of pediatric neurosurgery: ventriculoperitoneal, ventriculopleural, and ventriculoatrial. The text has been partitioned into the broad modes of shunt failure: obstruction, infection, mechanical shunt failure, overdrainage, and distal catheter site-specific failures. Clinical management strategies for the various modes of shunt failure are discussed as are research efforts directed towards reducing shunt complication rates. As it is unlikely that CSF shunting will become an obsolete procedure in the foreseeable future, it is incumbent on the pediatric neurosurgery community to maintain focused efforts to improve our understanding of and management strategies for shunt failure and shunt-related morbidity.

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Section: Obstructionmentioning

confidence: 99%

Cerebrospinal Fluid Shunting Complications in Children

Hanak

Bonow

Harris³

et al. 2017

Pediatr Neurosurg

176

110

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“…In addition, they demonstrated CSF eosinophilia due to gentamicin administration according to a positive Prausnite-Kustner’s skin test which showed an immediate drug allergy to gentamicin. Traynelis et al [13]demonstrated the presence of discontinuous sheets of inflammatory cells, lipidized macrophages and multinucleated foreign-body giant cells upon microscopic examination following shunt tube removal. Tung et al [14]suggested that patients with CSF eosinophilia undergo shunt replacement more frequently than those without eosinophilia based on his study of 36 patients.…”

Section: Discussionmentioning

confidence: 99%

A Case of Cerebrospinal Fluid Eosinophilia Associated with Shunt Malfunction

Tanaka¹,

Ikeuchi²,

Yoshino³

et al. 1999

Pediatr Neurosurg

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A 3-month-old female patient presented with a meningomyelocele at the lumber region associated with congenital hydrocephalus. She underwent ventriculoperitoneal (V-P) shunt surgery using the Sophy system. The shunt system was replaced due to a malformation. Following replacement, the patient presented with cerebrospinal fluid (CSF) eosinophilia at the age of 8 months. The eosinophilic granulocytosis of the CSF improved dramatically following systemic prednisolone administration. CSF eosinophilia without accompanying inflammation or pyrexia in the present case may have resulted from an allergic response to a foreign material such as the silicone tube pressure valve of the Sophy system or the sutures rather than bacterial or fungal infection. Based on our results, we believe that some patients may experience CSF eosinophilia following postoperative V-P shunt due to an allergic reaction to the shunt equipment. Prompt steroid treatment can produce spontaneous regression in such cases.

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“…Eosinophilia in the CSF developed with medications, including the Ibuprofen, Ciprofloxacin, Trimethoprim-sulfamethoxazole, and intraventricular Vancomycin or Gentamicin (Patey et al, 1988), the Ibuprofen caused eosinophilic meningitis in a healthy girl (Bansal et al, 2014) and Isoniazid, anti-tuberculosis drug for two months as acute eosinophilic myocarditis (Zhang et al, 2015). Sterile CSF eosinophilia has also been noted after myelography with contrast agents and can accompany ventriculoperitoneal shunt implantation or malfunction (Traynelis et al, 1988). In one series of children with ventriculoperitoneal shunts, approximately one-third experienced a CSF eosinophilia of more than 8% in the absence of peripheral blood eosinophilia; these patients were more likely to experience shunt infections and require shunt revisions (Tung et al, 1991).…”

Section: Introductionmentioning

confidence: 99%

Egyptian Eosinophilic and Infectious Meningoencephalitis and Their Impact on Psychological Aspects

EL-BAHNASAWY¹,

Feky²,

Morsy³

2016

JESP

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Meningoencephalitis is an acute inflammation of the brain and spinal cord & their covering protective membranes. Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency. The commonest symptoms of meningitis are headache and neck stiffness associated with fever, confusion or altered consciousness, vomiting, and an inability to tolerate light (photophobia) or loud noises (phonophobia). Children often exhibit only nonspecific symptoms, such as irritability and drowsiness. If a rash is present, it may indicate a particular cause of meningitis; for instance, meningitis caused by meningococcal bacteria may be accompanied by a characteristic rash. A broad variety of allergic, infectious, neoplastic, and idiopathic diseases are associated with increased blood and/or tissue eosinophilia and range in severity from self-limited conditions to life-threatening disorders. Although accepted upper limits of normal blood eosinophil numbers vary somewhat, a value above 600 eosinophils /microL of blood is abnormal in the vast majority of cases. Generally speaking, there are several possible causes of eosinophils in the CSF; undoubtedly parasitic infection is one of the main causes.

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Cerebrospinal Fluid Eosinophilia and Sterile Shunt Malfunction

Cited by 30 publications

References 0 publications

Cerebrospinal Fluid Shunting Complications in Children

Cerebrospinal Fluid Shunting Complications in Children

A Case of Cerebrospinal Fluid Eosinophilia Associated with Shunt Malfunction

Egyptian Eosinophilic and Infectious Meningoencephalitis and Their Impact on Psychological Aspects

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