Clinical Article Asymptomatic shunt malfunction detected fortuitously by observation of papilloedema

Summary Significant shunt malfunction is nearly always followed by headache, nausea, vomiting, lethargy and=or visual disturbances. In many cases there are also signs of raised intracranial pressure on computed tomography (CT). In six hydrocephalic, shunt dependent children (8–14,5 years) with no or slight symptoms shunt malfunction was detected because of papilloedema. The oedema was detected in three children at routine check up, in two at regular visual check up and in one at an ophtalmological examination because of slight headache. At neurological examination five had no new symptoms, but one was ataxic. In five patients a CT scan was done, three showed slight ventricular dilatation. Splayed sutures were found in two children. At shunt revision the measured intracranial pressure was increased, varying between 25–52 cm H2O. In five children the oedema disappeared after shunt-revision without any visual reduction, but in one the visual deficit did not improve. Older children can have shunt malfunction leading to increased intracranial pressure, with no or discrete symptoms and no obvious ventricular dilatation but with asymptomatic papilloedema. Ophtalmoscopy can therefore be of great value at routine check up in these children.