title: [Critical intracranial pressure crises in drained hydrocephalus with minimally enlarged or normal ventricles].
abstract: We report on 10 patients between 3 and 18 years of age who had been treated in the neonatal and postneonatal period for hydrocephalus of various causes with a ventriculo-atrial or ventriculo-peritoneal shunt. Between the age of 2 and 17 years these children suffered from recurrent attacks of headache, vomiting bradycardia and lethargy suggesting shunt-obstruction. 8 children showed slowing of electrical activity in their EEG, 4 had papilledema on fundoscopy. Splayed sutures were found in one child by skull x-ray. In all the above cases the CT-headscans assessed by radiologists showed no evidence of shunt-obstruction. Only on direct comparison with previous CT-scans we were able to detect minimally dilated ventricles in 6 children. In all cases conservative treatment failed. Symptoms only ceased after surgical shunt-revision. In all children treated with shunts headache, vomiting and vegetative symptoms must be considered as signs of shunt-obstruction until proved otherwise. A negative CT-scan done while symptoms are present cannot rule out raised intracranial pressure. Only by direct comparison with previous CT-scans carried out during an asymptomatic period a minor dilatation of the ventricles can often be detected. This should be taken as a sign of shunt-obstruction.
authors.affiliation: Universitäts-Kinderklinik, Universität Münster.
authors.forename: W
authors.initials: W
authors.lastname: Kölfen
authors.forename: R
authors.initials: R
authors.lastname: Korinthenberg
authors.forename: H
authors.initials: H
authors.lastname: Schmidt
mesh_terms: D000293:Adolescent; D002552:Cerebral Ventricles / Q000473:pathology*; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D004108:Dilatation, Pathologic / Q000473:pathology; D005260:Female; D006325:Heart Atria; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007427:Intracranial Pressure; D008297:Male; D010537:Peritoneum; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D014057:Tomography, X-Ray Computed
vernacular_title: Bedrohliche Hirndruckkrisen bei drainiertem Hydrocephalus mit minimal erweiterten oder normalen Ventrikeln.