Epileptic Seizure as a Sign of Cerebrospinal Fluid Shunt Malfunction

Johnson, Dennis L.; Conry, Joan A.; O’Donnell, Regina

doi:10.1159/000121043

Cited by 33 publications

(19 citation statements)

References 6 publications

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“…Seizures in patients with hydrocephalus are common (patients with 1 or more event: 6–59%). Patients with epilepsy quite frequently present shunt malfunction and VPS infection in combination with seizures [48,49]. …”

Section: Symptomsmentioning

confidence: 99%

Epidemiology, Prevention and Management of Ventriculoperitoneal Shunt Infections in Children

Prusseit

Simon²,

Brelie³

et al. 2009

Pediatr Neurosurg

115

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The advent of ventriculoperitoneal shunts (VPS) represented a substantial progress in the neurosurgical management of hydrocephalus in children. VPS infection is the most frequently observed complication. VPS infection is related to substantial morbidity and mortality, and exerts a negative impact on the quality of life of patients. Considerable personnel and financial resources have been devoted to its diagnosis and treatment. This article reviews the current literature and includes suggestions for the prevention, diagnosis and management of VPS infections.

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Section: Symptomsmentioning

confidence: 99%

Epidemiology, Prevention and Management of Ventriculoperitoneal Shunt Infections in Children

Prusseit

Simon²,

Brelie³

et al. 2009

Pediatr Neurosurg

115

View full text Add to dashboard Cite

show abstract

“…Parinaud’s syndrome has been described in patients with aqueductal stenosis and hydrocephalus [13, 17, 23, 24]. Both new-onset as well as recurrent seizures may be present at the time of shunt malfunction, though the incidence was reported to be quite low [14, 15]. Abdominal complaints may also be prominent, which may signal the presence of an abdominal CSF pseudocyst [25, 26, 27].…”

Section: Discussionmentioning

confidence: 99%

“…The clinical presentation of shunt malfunction varies greatly among the population, depending on the age, etiology of hydrocephalus and other factors [4]. Shunt malfunctions have been reported to cause visual compromise [6, 7, 8, 9, 10, 11, 12, 13], seizures [14, 15], fever [16]and midbrain or hypothalamic syndromes [17, 18, 19, 20]. Few previous studies, though, have dealt exclusively with the clinical presentation of pediatric shunt malfunction.…”

Section: Introductionmentioning

confidence: 99%

Unique Clinical Presentation of Pediatric Shunt Malfunction

et al. 1999

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Introduction: A cerebrospinal fluid (CSF) shunt is the primary treatment for most etiologies of hydrocephalus in the pediatric population. Malfunction of the shunt may present with unique symptoms and signs. This retrospective review investigates the presenting signs and symptoms of pediatric patients with shunt malfunction. Clinical Material and Method: One-hundred-and-thirty CSF diversion procedures were performed at two affiliated pediatric hospitals over a 2-year period. Seventy consecutive cases of CSF shunt revision were reviewed. These 70 operations were performed on 65 patients. Their medical records and radiographic studies were reviewed, and supplemented with a telephone interview to obtain a minimum of 3 months follow-up. Results: The 65 patients’ age ranged from 3 months to 16 years. The original etiology of the hydrocephalus was Chiari II malformation in 17, idiopathic in 15 and intraventricular hemorrhage in 10, neoplasm in 8 patients and meningitis in 5 patients. The most frequent presenting symptoms were headache (39 admissions), nausea/vomiting (28) and drowsiness (21). Seven Chiari patients (41%) presented with neck pain, 2 (12%) presented with lower cranial nerve palsy, and 2 (12%) presented with symptomatic syrinx, complaints not reported by non-Chiari patients (p < 0.01, χ² analysis). Four myelodysplastic patients presented with a new-onset or recurrent seizure episode, which was significantly more frequent than in nonmyelodysplastic patients (p < 0.05, χ² analysis). On examination, increased head circumference was noted in 17 patients. Parinaud’s syndrome was noted more prominently in patients with a history of intracranial neoplasm (4 of 8 cases) than in patients with nonneoplastic diseases (2 of 62 cases; p < 0.05, χ² analysis). Other interesting presenting signs were pseudocyst (2), syringomyelia (2), hemiparesis (2) and Parkinson-like rigidity (2). Conclusion: Pediatric shunt malfunction generally presents with headache, nausea/vomiting, altered mental status, increased head circumference and bulging fontanelle. Other less frequent but unique presenting signs and symptoms, such as neck pain, syringomyelia and lower cranial nerve palsy in the myelodysplastic population, and Parinaud’s syndrome in patients with a history of intracranial neoplasm are frequently associated with shunt malfunction and should prompt a radiographic workup.

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“…The efficacy of prophylactic use of anticonvulsants has never been established in patients undergoing shunt surgery, however. In addition, epileptic seizure could be a manifestation of shunt malfunction (Johnson et al, 1996). Very rarely, superficial siderosis of the central nervous system (Fig.3) has been reported after VP shunt (Satow et al, 2010).…”

Section: Ventriculoperitoneal Shunt (Vp Shunt)mentioning

confidence: 99%