Kosin Med J.  2021 Jun;36(1):44-50. 10.7180/kmj.2021.36.1.44.

Idiopathic Intracranial Hypertension following Ventriculoperitoneal Shunt Malfunction in Infant Hydrocephalus

Affiliations
  • 1Department of Neurosurgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
  • 2Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
  • 3Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

Abstract

Idiopathic intracranial hypertension (IIH) is a syndrome defined by elevated intracranial pressure without any abnormal findings. In the present study, we report a rare case of IIH in a patient after ventriculoperitoneal shunt (VPS) due to infant hydrocephalus. A 13-year-old girl with a history of VPS due to infant hydrocephalus was admitted to emergency room with the complaint of severe headache and visual disturbance. Brain computed tomography showed normal findings. However, based on the measurement by lumbar puncture, her cerebrospinal fluid (CSF) pressure was observed to be very high. The shunt function test revealed a VPS malfunction. Thus, we conducted VPS revision in this patient. All symptoms improved immediately after the revision. Thus, it is proposed that IIH should be considered for patients with visual disturbance and severe headache after VPS due to infant hydrocephalus without ventriculomegaly.

Keyword

Idiopathic intracranial hypertension; Infant hydrocephalus; Ventriculoperitoneal shunt

Figure

  • Fig. 1 (A) Preoperative brain computer tomography (B) Brain magnetic resonance T2 image showing intraocular protrusion of both the optic nerve heads (yellow arrows) (C) Brain magnetic resonance venography showing multifocal stenosis of bilateral transverse and sigmoid sinuses (yellow arrows) (D) Papilledema with marked circumferential disc elevation, and obstruction of vessels on the disc with multiple retinal hemorrhages in both the eyes were observed in fundus photograph.

  • Fig. 2 (A) Abdomen computer tomography axial and coronal images showing catheter tip (yellow circles) stuck in perihepatic space (B) Tc-99m diethylene-triamine-pentaacetate (DTPA) image showing the malfunction of both proximal and distal catheters.

  • Fig. 3 (A) There is no significant change in postoperative brain computer tomography (B) Optic disc swelling subsided and retinal hemorrhages were disappeared postoperatively.


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