Slit-ventricle Syndrome Presenting Spells of Respiratory Distress and Consciousness Disturbance, Associated with Significant Elevation of Intracranial Pressure

A case, 8-year-old boy with slit ventricle syndrome (SVS) is reported. The child received a ventriculo-peritoneal shunt operation at 9 months of age due to postmeningitic hydrocephalus. Since 4 years of age, he frequently showed intermittent severe headache, vomiting, respiratory disturbance, and drowsiness. The peritoneal catheter was revised to a high pressure one. However, similar symptoms recurred 2 years after the revisory procedure. On admission, in June 1985, he showed normal development and was neurologically free at the interval of the attacks. The syndrome started with progressing headache and vomiting. Thereafter, respiratory disturbance, intermittent apnea and drowsiness followed. CT scan taken during the attack presented collapsed ventricles. Epidural pressure monitoring showed significant elevation of the intracranial pressure. The symptoms became unmanageable in spite of mannitol infusion. CT scan proved a slightly enlarged lateral ventricle compared with the previous scan. Emergent revision of the shunt system was done. The ventricular catheter was obstructed with a piece of connective tissue, and thus a new ventricular catheter with anti-siphon valve was replaced. Postoperative course was uneventful and the symptoms have completely ceased.