title: Episodic ventriculomegaly due to hypernatremia mimicking shunt malfunction: case report.
abstract: Patients with shunted hydrocephalus presenting with altered mental status and ventriculomegaly are generally considered to be in shunt failure requiring surgical treatment. The authors describe a case of shunted hydrocephalus secondary to a disseminated neuroectodermal tumor in a pediatric patient in whom rapid fluctuations in sodium levels due to diabetes insipidus repeatedly led to significant changes in ventricle size, with invasively confirmed normal shunt function and low intracranial pressure. This clinical picture exactly mimics shunt malfunction, requires urgent nonsurgical therapy, and underscores the importance of considering serum osmolar abnormalities in the differential diagnosis for ventriculomegaly.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Jernigan
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Scellig S D
authors.initials: SS
authors.lastname: Stone
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Aronson
authors.affiliation: Medicine, Division of Endocrinology, Boston Children's Hospital; and.
authors.forename: Melissa
authors.initials: M
authors.lastname: Putman
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Proctor
mesh_terms: D001932:Brain Neoplasms / Q000150:complications; D002675:Child, Preschool; D003128:Coma / Q000209:etiology*; D003399:Craniotomy; D003919:Diabetes Insipidus / Q000150:complications; D003937:Diagnosis, Differential; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis* / Q000209:etiology; D006955:Hypernatremia / Q000150:complications / Q000175:diagnosis*; D019585:Intracranial Hypotension / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D018306:Neurocytoma / Q000150:complications; D012008:Recurrence; D012640:Seizures / Q000209:etiology*; D013702:Temporal Lobe / Q000473:pathology; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt
keywords: DDAVP = desmopressin acetate; FOR = frontal and occipital horn ratio; ICP = intracranial pressure; hydrocephalus; hypernatremia; shunt; ventriculomegaly