Acute hydrocephalus from VP shunt blockage

Case contributed by Ian Bickle
Diagnosis almost certain

Presentation

VP shunt in situ for hydrocephalus. Know posterior fossa mass - thought to be a meningioma. Headaches in recent days.

Patient Data

Age: 45 years
Gender: Male

Left parietal VP shunt with the tip in the body of the right lateral ventricle.

5.2 cm near isodense mass at the right cerebellopontine angle causing almost complete effacement of the 4th ventricle.

Moderate-severe resultant hydrocephalus.

Extensive periventricular low attenuation in keeping with trans-ependymal edema.

Case Discussion

On clinical examination, the patients subcutaneous port from the VP shunt was non-compressible in keeping with shunt blockage.

This is a good example of trans-ependymal edema from CSF exudation in the context of hydrocephalus. 

In this case despite the VP shunt as it is no longer functional.

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