title: Ventricular enlargement due to acute hypernatremia in a patient with a ventriculoperitoneal shunt.
abstract: Patients requiring CSF shunts frequently have comorbidities that can influence water and electrolyte balances. The authors report on a case involving a ventriculoperitoneal shunt in a patient who underwent intravenous hyperhydration and withdrawal of vasopressin substitution prior to scheduled high-dose chemotherapy regimen for a metastatic suprasellar germinoma. After acute neurological deterioration, the patient underwent CT scanning that demonstrated ventriculomegaly. A shunt tap revealed no flow and negative opening pressure. Due to suspicion of proximal shunt malfunction, the comatose patient underwent immediate surgical exploration of the ventricle catheter, which was found to be patent. However, acute severe hypernatremia was diagnosed during the procedure. After correction of the electrolyte disturbances, the patient regained consciousness and made a good recovery. Although rare, the effects of acute severe hypernatremia on brain volume and ventricular size should be considered in the differential diagnosis of ventriculoperitoneal shunt failure.
authors.affiliation: Department of Neurosurgery, Stanford University Medical Center, Stanford, California 94305, USA. randres@stanford.edu
authors.forename: Robert H
authors.initials: RH
authors.lastname: Andres
authors.forename: Arjun V
authors.initials: AV
authors.lastname: Pendharkar
authors.forename: Dominique
authors.initials: D
authors.lastname: Kuhlen
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
mesh_terms: D000208:Acute Disease; D000328:Adult; D050034:Antidiuretic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001254:Astrocytoma / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy; D020295:Brain Stem Neoplasms / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy; D002552:Cerebral Ventricles / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D016371:Cranial Irradiation; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage / Q000009:adverse effects*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D019544:Equipment Failure Analysis; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D006955:Hypernatremia / Q000150:complications* / Q000175:diagnosis; D006984:Hypertrophy; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy / Q000532:radiotherapy; D010911:Pituitary Neoplasms / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000209:etiology*; D003336:Tectum Mesencephali; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt
chemical_list: D050034:Antidiuretic Agents; D000970:Antineoplastic Agents; D003894:Deamino Arginine Vasopressin