Hyponatremic seizure due to huge abdominal cerebrospinal fluid pseudocsyt in a child with ventriculoperitoneal shunt: a case report

Abstract

Placement of ventriculoperitoneal(VP) shunt is a worldwide accepted procedure for treatment of hydrocephalus. This procedure have various intra-abdominal complications, of which pseudocyst formation is a rare one. Common presentations of this complication are abdominal mass, abdominal pain, intestinal obstruction, and shunt dysfunction. In this paper, we report a case of 3 year-old boy with cerebrospinal fluid (CSF) pseudocyst of the VP shunt presenting with hyponatremic seizure. To the best of our knowledge, hyponatremic seizure has not been previously reported as a presentation of abdominal CSF pseudocyst in the literature. Our case has also the largest CSF pseudocyst with respect to body surface area of the child in the literature.KeywoRds: Children, Hyponatremia, Seizure, Pseudocyst, Ventriculoperitoneal shunt ÖZHidrosefali tedavisinde ventriküloperitoneal (VP) şant yerleştirilmesi dünya çapında kabul görmüş bir yöntemdir. Bu yöntemin çeşitli karın içi komplikasyonları vardır. Psödokist oluşumu bu komplikasyonlardan nadir olan biridir. Bu komplikasyon sıklıkla batında kitle, karın ağrısı, barsak tıkanıklığı ve şant fonksiyon bozukluğu ile bulgu verir. Bu yazıda, VP şanta bağlı serebrospinal sıvı psödokisti gelişen ve hiponatremik nöbetle bulgu veren 3 yaşındaki erkek olguyu rapor ettik. Şu andaki bilgilerimize göre, hiponatremik nöbetle bulgu veren batın içi serebrospinal sıvı psödokisti literatürde daha önceden rapor edilmemiştir. Ayrıca olgumuz vücut yüzey alanına göre literatürdeki en büyük psödokiste sahiptir.

Development of severe hyponatremia due to cerebrospinal fluid leakage following meningomyelocele surgery in a newborn

“…This amount exceeds the daily sodium intake (6 mmol) of a newborn receiving 600 ml of breast milk (mean sodium content 0.74 mmol/dl) or term infant formula (sodium content 0.78-0.87 mmol/dl). Based on the present case and on previously reported cases, 1,6,15,16 CSF loss may cause severe hyponatremia, particularly in the newborn and early infancy periods when dietary sodium content is relatively low. The sodium content of standard maintenance fluids in this age group is about one-fourth to one-fifth of 0.9% saline, which cannot compensate for sodium loss through a CSF leak.…”

“…15,16 In addition, hyponatremia associated with CSF loss has been reported in a 3-year-old child following ventriculoperitoneal shunt placement for an abdominal CSF pseudocyst and in an 18-month-old infant with rhinorrhea. 1,6 The sodium content of CSF varies between 135 and 150 mmol/L. Daily CSF loss of 100 ml causes sodium loss of 14 mmol.…”

Abdominal Cerebrospinal Fluid Pseudocyst Diagnosed with Point-of-care Ultrasound

“…No statistically significant link has been demonstrated between the size of the pseudocyst and the risk of infection 14. Reported complications of abdominal pseudocysts include hyponatremic seizures and inferior vena caval, ureteral, and intestinal obstructions, secondary to mass effect from the pseudocyst 15,16…”

Unusual cause of abdominal distension: Infected abdominal cerebrospinal fluid pseudocyst

“…Abdominal complications of VP shunts include peritonitis, ascites, bowel and abdominal wall perforation and inguinal hernias 1,2 . ACP is a rare complication of VP shunts and the incidence is less than 1% 3,4 .…”

“…Main criteria for the diagnosis are presence of an intraperitoneal fluid collection with well-defined margins and the identification of the distal tip of VP shunt near or within the APC [5][6][7][8] . Pathophysiology is not clear though infections, allergic reactions to silicone or ethylene oxide and previous abdominal surgeries are known predisposing factors 2 . Staphylococcus aureus, Staphylococcus epidermidis and Propionibacterium acnes are the common bacterial isolates from ACP 1 .…”