| Complication |
Frequency |
Etiology |
Clinical Presentation |
Diagnosis/Work-up |
Management |
| Mechanical Failure |
8%-64% |
Occlusion, fracture of tubing, disconnection of components, migration of shunt |
- Decreased level of consciousness (LOC)
- Bulging fontanelle
- Fluid tracking around the shunt
- Irritability
- Nausea/vomiting
- Increased head growth
- Loss of developmental milestones
- Headache
- Less common: Diplopia, visual loss
|
- Shunt series (fracture/disconnection)
- CT of head, head ultrasound (ventricular enlargement)
- Less common: Radionuclide shuntogram
|
Shunt exploration and revision |
| Infection |
3%-12% |
Staphylococcus epidermidis (50%), Staphylococcus aureus (25%), anaerobic bacteria (e.g., Corynebacterium diphtheriae, Propionibacterium acnes) (10%) |
- Fever
- Erythema
- Meningismus
- Abdominal pain
- Peritonitis
- Wound breakdown
- Purulent discharge
|
CSF biochemistry, cell count, and culture (positive) |
Externalization of shunt, IV antibiotics |
| Overdrainage |
3%-5% |
Siphoning, inappropriate valve setting |
- Headache
- Nausea/vomiting
- Diplopia
- Subdural hematoma/extra-axial fluid collections
- Craniosynostosis
- Slit ventricle syndrome
|
- CT of head, head ultrasound (slit ventricles, extra-axial fluid collections, subdural hematoma)
|
- Observation
- Shunt revision (higher pressure/programmable valve)
- ± Drainage of extra-axial collections
|