Changes in visual acuity associated with shunt failure.
OBJECTIVE
The object of this article was to report on a retrospective analysis of the clinical findings in a series of patients with changes in visual acuity associated with shunt failure.


RESULTS
Over a 10-year period, 350 patients underwent revisions for shunt failure. The clinical course of patients who demonstrated changes in visual acuity (VA) before or during hospitalization were reviewed; follow-up was achieved using outpatient records and telephone calls with physicians, family, or caregivers. Six patients (4 male) ranging in age from 2.5 years to 40 years demonstrated changes in vision associated with shunt failure. The youngest patient lapsed into coma before transfer and showed bilateral occipital lobe infarctions on the CT scan. Three patients had no complaints referable to the visual system prior to revision. Two patients with symptoms lasting more than 21 days showed unequivocal signs of increased intracranial pressure. Serial CT scans remained unchanged in 2 patients. A 3rd patient showed questionable progression in ventricular volume, while another patient's ventricles dilated after a period of 48-72 h. Four patients demonstrated a pattern of aqueductal stenosis, long-term shunting without revision, small ventricles, and poor outpatient follow-up. Four patients showed partial or complete recovery following revision.


CONCLUSIONS
Changes in vision are uncommon and can be an isolated finding associated with shunt failure. Patients with aqueductal stenosis, long-term shunting without revision, and small, potentially non-compliant ventricles may be at risk of this complication. Misdiagnosis or inadequate follow-up places these patients at additional risk, but rapid revision can result in partial or complete recovery.
Kraus
Robert
R
Department of Neurosurgery, University of Illinois College of Medicine, PO Box 1649, Peoria, IL 61656, USA.
Hanigan
William C
WC
Kattah
Jorge
J
Olivero
William C
WC
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects* / Q000295:instrumentation; D014786:Vision Disorders / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D014792:Visual Acuity; D014794:Visual Fields