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Case: Shunt Failure

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Here is a patient who was discharged

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on November 11th with this MRI scan.

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After a revision of the ventriculostomy

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catheter, you see the high signal intensity in

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the scalp of edema from that surgical revision.

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This is the reservoir of the ventriculostomy

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catheter, and we see the catheter coursing

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from the right frontal region into the

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lateral ventricular system, crossing the midline to

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get into the left lateral ventricle. And this is

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the baseline imaging after revision of the shunt.

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Two weeks later, the patient has fever,

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lethargy, and is not eating well.

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The mom brings the patient in. Here,

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we can see the follow-up examination.

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We notice the change in the ventricular size,

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that this is much larger compared to the

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contralateral side. The position of the catheter

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is approximately the same, and what one often sees

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in patients who have shunt failure is that the

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fluid collection at the reservoir has expanded.

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Normally, it would be flat, and there

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wouldn't be fluid under the scalp.

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In this case, the patient has had shunt failure,

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and you get a larger CSFoma in the scalp region,

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secondary to the shunt malfunction.

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So this comparison study—again,

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this is a T2-weighted scan.

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It's a HASTE image.

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You see we do it in the axial plane, as well as the

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sagittal plane and the coronal plane.

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These three sequences take about three minutes total to

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perform, analogous to a CT scan but without radiation.

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And we compare that with the follow-up examination,

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where you have the enlargement of the

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lateral ventricles. It's very nice

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and eliminates the need for radiation.

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Uh, it's been said that patients who

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have ventriculostomies placed

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as a child, on average, have about 25 studies

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performed in their lifetime to check for ventricular

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size because every time they get sick, have

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lethargy, or have failure to thrive, the parents are

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worried about the possibility of a shunt failure,

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and they bring the patient into the emergency room.

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Imagine the cumulative effect of that radiation if

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we are doing CT scans again and again and again

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of the patient's head.

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If we are doing CTs to evaluate for shunt

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failure. So now we use fast HASTE imaging on an MRI

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scan. In this case—new lethargy, shunt failure.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

MRI

Iatrogenic

Emergency

Brain

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