Cerebral fluid edema: an unusual complication of ventriculoperitoneal shunts

Isolated left homonymous hemianopia secondary to a pericatheter cyst-a rare presentation of a ventriculoperitoneal shunt failure

A 26-year-old woman developed a left homonymous hemianopia 1 week after placement of a ventriculoperitoneal shunt through a right parieto-occipital approach. Computed tomography demonstrated a parenchymal cyst in the right occipital lobe. After shunt revision, there was concomitant resolution of the cyst and visual field defect over 1 month. The literature is reviewed regarding this unusual complication of ventriculoperitoneal shunt failure.

[Cerebral fluid edema: a rare complication of ventriculoperitoneal shunt]

Physiopathologic knowledge of hydrocephalus allows progress in the conception of modern shunts. With better controlled surgical techniques, shunting has revolutionized the prognosis of hydrocephalus. However, peritoneal or atrial shunting is not harmless, as illustrated by the large number of reported complications. We describe here an unusual complication of ventriculoperitoneal shunt dysfunction revealed by focal cerebral edema in a 60-year-old patient. Preoperative cerebral CT scan showed the focal brain edema with diffusion of cerebrospinal fluid around the trajectory of the ventricular catheter. Abdominal CT scan demonstrated distal shunt dysfunction. Clinical and radiological outcome was good after surgical revision of the shunt, confirming the diagnosis.