Shunts are essentially plumbing devices that drain cerebrospinal fluid from either the ventricle of the brain or the subarachnooid space of the spine to another part of the body, usually the peritoneal cavity or the circulatory system. The purpose of this drainage is to prevent the buildup of pressure from a backup of the CSF that is not draining due to obstruction or reduced absorption of CSF. When a shunt, which is a mechanical device becomes broken or clogged in a patient who depends on that shunt, an emergency exists in that a limited amount of tiime is available to rectify the shunt failure before the pressure buildup results in neurologic damage.
Symptoms of shunt failure are headache, nausea, vomiting, confusion, double vision, and almost any other neurological sign. The surgeon works up the possible shunt failure with a number of exams that may include a CT scan of the head, a brain MRI, a shunt x-ray series, a contrast injection into the shunt done under fluoroscopy or a shunt tap to check flow.
When the failed shunt part or function is identified, surgery may need to be performed to establish CSF flow. It is important to establish flow before the pressure builds up to a level that causes herniation of the brain. All shunts have a limited lifespan, although many shunts last for many years. Usually the ventricles are enlarged when there is shunt failure although in some cases, the ventricles do not enlarge such as when there is slit ventricle syndrome.
Medical negligence claims are filed when patients who are shunt dependent are damaged when they not treated in a timely fashion after the onset of shunt flow obstruction. Shunt management can be simple or complex depending on a number of factors. A reasonable approach to diagnosis and treatment, including timing, is critical to the shunt dependent patient.
