%0 Journal Article
%T Two Episodes of Ventriculoperitoneal Shunt Migration in a Patient with Idiopathic Intracranial Hypertension
%A V. Balakrishnan
%A R. Jeanmonod
%J Case Reports in Emergency Medicine
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/280793
%X Introduction. Ventriculoperitoneal shunts are often placed as treatment for refractory idiopathic intracranial hypertension. Dislodgement and migration of the distal portion of the shunt are more common in obese patients and can be difficult to detect. We report the case of a woman with two separate episodes of shunt migration into her abdominal wall. Case Presentation. We report a case of a 37-year-old female with history of obesity eventually diagnosed with idiopathic intracranial hypertension (IIH) as the cause. She failed outpatient therapy and, through neurosurgery, had a VP shunt placed for symptom control. She had subsequent development of worsened symptoms that were found to be due to shunt migration. This happened not once but twice to the same patient. Conclusion. Shunt dislodgement, migration, and subsequent failure are common in obese patients who have shunts placed for IIH. The medical provider should maintain a high index of suspicion for shunt malfunction in these patients, particularly because clinical evaluation may be challenging due to habitus. 1. Introduction Ventriculoperitoneal shunts are often placed as treatment for refractory idiopathic intracranial hypertension. Dislodgement and migration of the distal portion of the shunt are more common in obese patients and can be difficult to detect. We report the case of a woman with two separate episodes of shunt migration into her abdominal wall. 2. Case Presentation A 37-year-old female with a history of obesity presented to the emergency department (ED) multiple times over 1 year for the evaluation and treatment of headaches. She had poor control of these headaches despite appropriate medical management including acetazolamide, therapeutic lumbar punctures (LPs), and narcotics for the purported origin of pain being idiopathic intracranial hypertension (IIH) (formerly pseudotumor cerebri). Because of the chronicity of her visits to the ED and poor control of symptoms, neurosurgery made the decision to place a ventriculoperitoneal (VP) shunt. The surgery was successful, and postoperative radiographs confirmed appropriate position of the shunt. The patient was subsequently discharged home. Ten days after the procedure, the patient presented to the ED for a wound evaluation. She had noticed some swelling at the superior aspect of her abdominal wound. The patient reported that she had felt a ˇ°popˇ± in her abdomen while leaning over and straining to have a bowel movement a few days prior. Her exam was remarkable for mild induration and tenderness at her surgical incision. She was diagnosed
%U http://www.hindawi.com/journals/criem/2014/280793/