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Surgery
Slit-ventricle syndrome masking shunt disconnection in adulthood
  1. Marta Casanovas Ortega1,
  2. Anand S Pandit1,2,
  3. Zeid Abussuud1 and
  4. Laurence D Watkins1
  1. 1Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
  2. 2High-Dimensional Neurology, University College London, London, UK
  1. Correspondence to Dr Marta Casanovas Ortega; m.casanovasortega{at}nhs.net

Abstract

A male in his 20s was referred to the neurosurgical service with headaches, vomiting and personality changes. He had a previous history of bilateral ventriculoperitoneal (VP) shunts and bitemporal decompressive surgery for neonatal intraventricular haemorrhage. There were appearances of slit-ventricles on his CT head scan typically associated with adequate cerebrospinal fluid drainage and normal intracranial pressure (ICP), which ordinarily will have limited further investigation. However, an X-ray shunt series demonstrated a right shunt disconnection at the neck and ICP monitoring confirmed raised ICP with poor brain compliance. He underwent revision of the right VP shunt with distal catheter replacement. Postoperatively, his symptoms, ICP and brain compliance improved.

This case highlights the value of obtaining shunt series in patients presenting with symptoms of shunt obstruction regardless of a normal CT head. It emphasises awareness of slit-ventricle syndrome in adult patients with shunts, particularly those with complex childhood hydrocephalus.

  • Neurosurgery
  • Hydrocephalus

https://doi.org/10.1136/bcr-2024-260593

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: MCO, ASP, ZA. The following authors gave final approval of the manuscript: LDW. CO is responsible for the overall content as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.