title: Delayed diagnosis of shunt overdrainage following functional hemispherotomy and ventriculoperitoneal shunt placement in a hemimegalencephaly patient.
abstract: Shunt overdrainage represents a nebulous condition of variable clinical and imaging presentations, where the diagnosis is primarily clinical. The condition presents a diagnostic challenge particularly in patients with cognitive impairment and developmental delays. Here we present a 3-year-old boy with drug-resistant focal onset seizures due to hemimegalencephaly who previously underwent functional hemispherotomy followed by ventriculoperitoneal shunt placement for postoperative hydrocephalus. The subsequent clinical course was complicated by delayed diagnosis of shunt overdrainage in the absence of significant image findings. Maintaining a high index of suspicion for the possibility of shunt overdrainage is critical even in the face of unremarkable imaging findings.
authors.affiliation: Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Nagahama
authors.affiliation: Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Peters
authors.affiliation: Surgery residency program, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Kumonda
authors.affiliation: Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Vesole
authors.affiliation: Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Charuta
authors.initials: C
authors.lastname: Joshi
authors.affiliation: Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: J Dlouhy
authors.affiliation: Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kawasaki
keywords: Hemimegalencephaly; Hemispherectomy; Peri-insular functional hemispherotomy; Postoperative hydrocephalus; Shunt overdrainage