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31 - Hydrocephalus and Shunts in Children

from SECTION V - PEDIATRIC NEUROLOGICAL EMERGENCIES

Published online by Cambridge University Press:  06 August 2009

Stephen Guertin
Affiliation:
Sparrow Healthcare System Lansing, Michigan
Anthony Briningstool
Affiliation:
Sparrow/MSU Emergency Medicine Residance Program Lansing, Michigan
Sid M. Shah
Affiliation:
Michigan State University
Kevin M. Kelly
Affiliation:
Drexel University, Philadelphia
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Summary

Most children with cerebrospinal fluid (CSF) shunts who present with irritability, headache, vomiting, and fever are more likely to have a viral illness than a shunt malfunction. Almost all CSF shunt systems have intraventricular tubing, a valve apparatus, and distal tubing. Distended scalp veins or bulging of the fontanel or a craniotomy site indicates high intracranial pressure (ICP) in the process of inspection of the shunt system. A sunken fontanel and sunken craniotomy site indicate low ICP. Proximal obstruction of the ventricular catheter of the CSF shunt system occurs from cellular debris, fibrosis, infection, envelopment by the choroid plexus, and catheter migration. Furosemide (1 mg/kg per day) with or without mannitol is also used to lower elevated ICP. In addition to the shunt malfunction, the two commonly encountered complications of long-term CSF shunt systems are slit ventricle syndrome and ventriculitis.
Type
Chapter
Information
Principles and Practice of Emergency Neurology
Handbook for Emergency Physicians
, pp. 313 - 324
Publisher: Cambridge University Press
Print publication year: 2003

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References

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