Fatal ventriculoperitoneal shunt occlusions diagnosed at autopsy
- PDF / 7,666,038 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 35 Downloads / 223 Views
CASE REPORT
Fatal ventriculoperitoneal shunt occlusions diagnosed at autopsy Joshua White 1 & Phillip Key 1
&
Joseph A. Prahlow 1
Accepted: 2 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The placement of a ventriculoperitoneal (VP) shunt is frequently used in the management of chronic hydrocephalus. Failure of the shunt may occur due to physical obstruction, which is a recognized complication. Autopsy examination of deceased individuals with chronic disability is often not performed, which contributes to the difficulty in determining the frequency of mortality from VP shunts. Examination, when it does occur, should focus on the patency and positioning of the shunt, and this evaluation is especially important when the cause of death is poorly defined. In this report, we describe two cases of death caused by obstruction of VP shunts documented at autopsy. The first death was determined to be secondary to cerebellar edema with uncal and tonsillar herniation after posterior left VP shunt occlusion. The second was due to VP shunt occlusion resulting in diffuse cerebral edema and ventricular enlargement with compression and hemorrhage of the cerebellar tonsils and medulla. Keywords Forensic pathology . Ventriculoperitoneal shunt . Hydrocephalus
Introduction Ventriculoperitoneal (VP) shunting is the most common form of treatment for hydrocephalus, used in 98% of pediatric hydrocephalus patients and more than 80% of adult patients [1]. The purpose of a VP shunt is to allow cerebral spinal fluid (CSF) to exit the cerebral ventricular system via an artificial pathway. A typical VP shunt is comprised of a proximal (inflow) catheter inserted into the ventricular system, a valve with reservoir, and a distal (outflow) catheter inserted into the peritoneal cavity (Fig. 1). Treatment with a VP shunt is typically long-term, often in patients with debilitating disease, such as when placed for congenital hydrocephalus that may be associated with comorbidities like cerebral palsy [1]. These chronic devices require ongoing surveillance and are unfortunately at a high risk for failure. Many patients eventually require revision or replacement [2, 3]. The mortality associated with shunt failure is poorly defined and fatal shunt failure is infrequently encountered in forensic literature. Here we present 2 cases of fatal VP shunt
* Phillip Key [email protected] 1
Western Michigan University Homer Stryker MD School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, USA
failure that directly caused the death of patients being treated for congenital hydrocephalus.
Case history and autopsy findings Case 1 The first case involved a 23-year-old female with a history of congenital hydrocephalus, cerebral palsy, and seizure disorder. She had a VP shunt placed shortly after birth which was revised at 15 months. She lived in a group home facility requiring significant assistance from caretakers. The patient was admitted to hospital with a complaint of abdominal pain with nausea and
Data Loading...
