DDX of ventriculoperitoneal shunt malfunction

Approach to the DDX of ventriculoperitoneal shunt malfunction:

  • Look at shunt series to determine if
    — Shunt is broken, discontinuous, kinked or tip has migrated out of ventricle
  • If shunt is radiographically normal and neuroimaging shows ventricular dilation with shunt tip in ventricular system
    — Assume shunt is occluded
  • If shunt infection suspected use neuroimaging to look for
    — Ventriculitis, meningitis, fluid around shunt reservoir
  • If neuroimaging shows ventricles are slit-like
    — Consider over-shunting
  • If abdominal symptoms are present
    CSFoma should be searched for