The Challenge of Diagnosing Shunt Dysfunction

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Researchers aim to improve the way that physicians identify problems with a shunt system

By: Jacob Getzoff and Dr. Jenna Koschnitzky, HA Director of Research Programs

Shunt placement is the most common treatment for those living with hydrocephalus, but complications within a shunt system can develop over time. Persistent headaches, vomiting, and drowsiness are all signs that a shunt system may not be functioning properly. While these symptoms are associated with shunt dysfunction, the symptoms could also be indicative of an illness or disorder not related to the shunt. This poses a challenge for our community and for physicians. In addition, when the symptoms are related to the shunt system, the symptoms do not tell physicians which part of the shunt is not functioning properly.

 

In many cases, diagnostic imaging, such as CT scans or X-rays, is performed to rule in or rule out shunt dysfunction. These imaging tests expose patients to radiation, and many times these tests indicate that the shunt is in fact working properly. Although a working shunt is good news for a patient with hydrocephalus, unnecessary radiation exposure is not.

Researchers at the University of Zürich asked the question, “Is there a better way to diagnose shunt dysfunction and reduce radiation exposure?” The team analyzed data from the medical records of 148 adult patients admitted for suspicion of a shunt dysfunction at the University Hospital of Zürich. They analyzed the data for commonalities between the cases that could help them optimize the diagnostic process.

 

The researchers found that only 46% of patients admitted had a shunt dysfunction, while the vast majority of the remaining 54% were unnecessarily subjected to radiating diagnostic procedures. After analyzing patient symptoms, they found that an abdominal cyst is highly indicative of abdominal dislocation. However, for all other types of shunt dysfunction observed, they were unable to identify any specific symptom or combination of symptoms that could reliably differentiate shunt dysfunction from other diagnoses.

Table 1: Relationship between the causes of shunt dysfunction and the time after shunt placement or revision in adult patients with hydrocephalus.

Table 1: Relationship between the causes of shunt dysfunction and the time after shunt placement or revision in adult patients with hydrocephalus.

 

 

While the analysis of symptoms did not show much potential for improving diagnostics, the researchers did find a relationship between why a shunt stopped working properly and how long ago the shunt was implanted (Table 1). In these adult patients, infections and abdominal dislocations were most common in the first six months, over-drainage and under-drainage were most common from six months to four years, and disconnections, kinking, and laceration were most common four years or more after shunt placement. The rate of shunt obstruction (blockage) was steady during all time periods after six months.

 

Using this new information, the researchers devised a decision tree to help reduce the use CT scans and X-rays in adults with symptoms of shunt dysfunction. However, the effectiveness of this decision tree still needs to be evaluated and is the subject of a subsequent study that is currently under way at the University of Zürich.

 

The research team consisted of José M. Spirig, Melanie N. Frank, Luca Regli, and Lennart H. Stieglitz. The full article can be found here.

21 Comments for : The Challenge of Diagnosing Shunt Dysfunction
    • Amanda
    • July 27, 2019
    Reply

    I have had 2 straight days of a pinching feeling in my shunt. It is on the left side of my head. I can’t figure out what is going on and my Dr. wants me to do a Latency test but I can’t afford it even with insurance.

    • Karen Rye
    • July 4, 2019
    Reply

    After ACM decompression surgery in 1991, now 2019 shunt is at L3 to S1, believed to be orginally placed in cervical spine during chiari surgery. Current issues in lumbar include spinal stenosis, degenerative disc disease and sciatica.
    How common is it that the shunt migrates down to lumbar?
    Kare rye

    • Elizabeth
    • May 16, 2019
    Reply

    My name is Elizabeth Hickman I’m 35 year old I had my last shunt put in 2004 and now it’s been hurting an going town my neck I stay sick to my stomach I can’t get it to stop hurting can you help me I tired of hurting all the time

  1. Reply

    I had my shunt put in my head around 1987. On my right side of my head lately I’ve been getting a sore neck and the back of my head hurts. Some headaches, some dizzy spells. I will be 52 in July.

    • Donna Toomey
    • April 18, 2019
    Reply

    I had a shunt placed in this past June. After the procedure I had pain in my neck just below my hairline. The neuro said it was probably just a stiff neck from the way I was placed on the operating table. Well now it is April and the pain is unbearable. It radiates all the way down both of my arms and down my back to between my shoulder blades. Of course pain management would not give me anything except lidocaine patches which do nothing. Now after a lot of loud voices I insisted there was something wrong. I can not even raise my arms to brush my hair. I am a 65 yr old woman who used to work out every day untile this pain started. P.T. made it alot worse. Now the neuro wants me to have an MRI done next week. Is that a safe thing to do because of the magnets? Any advice would be appreciated. Thanks, Donna

    • Amy
    • March 24, 2019
    Reply

    Redness along shunt tract, potentially present with shunt failure or infection; Older Adults with Normal Pressure Hydrocephalus. People who are diagnosed and treated in adulthood, including those with NPH, tend to revert to the symptoms they experienced before initial treatment when they are experiencing a shunt malfunction.

    • Emilee
    • February 3, 2019
    Reply

    I got in a car accident in 2010 and had bilateral craniotomies. They put those back in, along with a vp shunt. Since 1/29/19, so it’s been about a week, the back of my head has been hurting, my neck has been really stiff, and my ears plug up so its hard to hear. The weird thing is, it only lasts for about 4 mins. then goes away. That happens about 5 or 6 times a day. Should I be worried? It has been a little over 8 years since I got the vp shunt put in.

    • Melanie
    • February 3, 2019
    Reply

    Wow, so helpful to read these comments. My 28 year old son has had a shunt for 26 years, is non verbal. I never know why he seems uncomfortable, and at times screaming. I did not know the shunt could be uncomfortable bc he was so MUCH MORE in pain prior to getting the shunt (screamed constantly). He has had one revision and they left the old tubing in his abdomen saying it was more difficult/dangerous to remove it. I have often suspected that is causing him issues. I welcome advice/input/suggestions. Over the years I have had the neurosurgeon check his shunt (MRI, shunt series, etc…)and all appeared normal.

    • ann
    • November 27, 2018
    Reply

    i am 33 years and had 3 revision, my last was 17 years ago. i am now experiencing problems with it: i have headaches, double vision am irritable, cant concentrate, suffers from anxiety, cant function l feel worthless.ike a normal person. sometimes I feel depressed. Any advise out there?

      • Lakisha Harris
      • December 4, 2018
      Reply

      Hello Ann,

      Thank you for your question. If you are experiencing returning or new symptoms, I would like to suggest you speak with your specialist. Please view the signs and symptoms of complications using the following link https://www.hydroassoc.org/signs-and-symptoms-of-complication/.

      All the best,
      Support and Education Team

    • Godday
    • October 27, 2018
    Reply

    I have had a shunt surgery but do experience severe headache whenever I sits up but no headache when I lay down

      • Tisha Rios
      • January 20, 2019
      Reply

      That sounds like a spinal headache from over drainage.

    • Girly
    • September 5, 2018
    Reply

    Does shunt infection can be determined by just one symptoms like a fever for 5 days? There’s no other signs like vomiting or stiffness… 🙁

    • Dee
    • May 8, 2018
    Reply

    I have a VP shunt, my first one was put in in 1995, it was then revised two years later in 1997…I have still suffered from headaches since the insertion…Right now 8/5/2018 I’m unwell…Severe headache no amount of pain killers are helping, vomiting but ive been unwell for 5 days, nausea and headache vomiting has just started today…Waiting on appointment for an Mri…If it Gets too much I’ll forget the Mri and go straight to hospital…
    I hate having this disease!!!
    In the past I’ve had what I call hydro headaches where I’ll get up in the morning and first thing I do is vomit…Ive had instant blockages and have had blackouts and also even hospitalization due to over shunting and the ventricle collapsing….
    My hydrocephalus was caused by bacterial meningitis as a 9 yr old BUT I went 20 yrs misdiagnosed many times by different doctors…I have permanent problems with my eyesight I wear glasses for reading and different glasses for driving…Ive been to an opthalmologist who says the damage is permanent for having untreated hydrocephalus he says it looks like I have glaucoma but it’s not progressive…
    I am also deaf in my right ear which is also permanent…
    Lots of issues having a a VP shunt…Having mine removed is not an option…I wish!

      • Mike
      • January 15, 2019
      Reply

      I had my shunt fitting in 1995

      Still have the same shunt today

      I’ve had head ache on and off can’t seem to sleep. Everything just seems yo be harder to do.

    • joana
    • April 20, 2018
    Reply

    My baby have shant but the problem is he have something big on the righten site of his ear were the shunt inserted. It is the sign of blockage ?

      • M
      • August 6, 2018
      Reply

      The bump beside the ear is normal. That’s the shunt. You should see a littl tube go down the side of the next too like the size of a straw

  2. Reply

    I have a VP shunt. I have had mine since 2010. I’ve had no problems thus far and I also work part time.

    • Maureen
    • August 28, 2017
    Reply

    My son was diagnosed with adult onset NPH age 48, normal pressure hydrocephalus, which is an abnormal condition of the brain causing fluid build up and enlarged ventricles. UCSD Brain surgeon, Dr Wilson, did a new procedure…. opened a channel from top of brain down through back of nose to open passway for excess water build up to drain back to spinal column. No side effects, no maintenance. Truly remarkable!

    • Shirley Dupree
    • August 17, 2017
    Reply

    I hope you find a cure for hydrocephalus!
    I have it and I had a shunt but it has been removed due to severe infection in the part that was in my stomach. I’ve had a lot of problems from the shunt. It was worth having it removed. I had it for a year , which was a year of hell. I hope I never have to go through that again!

      • Will Michael
      • August 17, 2017
      Reply

      You had yours removed? Was it a VP shunt? Was it a process or Dr they simply pull it out? I have had a VP shunt for 7 months and I have had moderate to severe abdominal pain for the past 6 months. I didn’t know removing it was an option!

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