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اختلاط لتركيب شنط دماغي


اختلاط لتركيب شنط دماغي


حالة سريرية

كتابة حرة وطرح موضوع النقاش!

A 2-year-old boy was diagnosed with hydrocephalus shortly after birth. At age 3 months he
had a ventriculoperitoneal shunt placed. The family has been instructed to manually pump the
shunt at regular intervals, and they know where the pump is located over the rib cage. In the
last 3 days the child has become irritable, complains of headache, and has developed nausea
and vomiting. This morning the family noted impairment of upward gaze. These symptoms
suggest which of the following situations?
A. Intracranial bleeding
B. Obstruction of the shunt
C. Shunt infection
D. The child has outgrown the shunt
E. The child no longer needs the shunt

by

The correct answer is B. Obstruction and infection are the two main complications of
these shunts
. The symptoms in this child suggest increased intracranial pressure, and
the problem with upward gaze signals ballooning of the suprapineal recess. Obstruction
is the obvious cause. Obstruction can happen even when pumping is done regularly.
Bleeding (choice A) is uncommon as a shunt complication. Infection of the shunt
(choice C) produces malaise and fever.

Infection may or may not interfere with shunt flow. When it does, it tends to produce
recurrent episodes of malfunction.
Children often outgrow ventriculo-atrial shunts, but there is more leeway with the length
of an intraperitoneal catheter. Choice D is therefore unlikely to explain the problem.
The child is in trouble, and the trouble is increased intracranial pressure, and he
therefore still needs the shunt, which makes choice E incorrect.
qusei
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