Ventriculopleural shunt dysfunction as the first sign of a hidden aneurysmal Subarachnoid Hemorrhage: A case report
| Autor: | Heberseleth Valdivia-Chiñas, Rafael Sánchez-Mata, José Ramón Aguilar-Calderón, Erick Alberto Castañeda-Ramírez, Rodrigo Efraín Hernández-Resendiz, Daniel Alejandro Vega-Moreno, María Elena Córdoba-Mosqueda, Óscar Medina-Carrillo |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Subarachnoid hemorrhage Ventricular system Ventriculopleural shunt 03 medical and health sciences 0302 clinical medicine Cerebrospinal fluid Case report medicine Lumbar puncture Cerebral aneurysms SAH Subarachnoid Hemorrhage LP Lumbar Puncture medicine.diagnostic_test business.industry General Medicine CT Computed Tomography medicine.disease Shunt (medical) Surgery 030220 oncology & carcinogenesis Angiography Shunt dysfunction 030211 gastroenterology & hepatology Differential diagnosis business CSF Cerebrospinal Fluid |
| Zdroj: | Annals of Medicine and Surgery |
| ISSN: | 2049-0801 |
| Popis: | Introduction Subarachnoid Hemorrhage (SAH) is caused by an aneurysmatic origin in 80% of cases. In the adult population, the risk of shunt dysfunction is about 16% in the first year, with proximal mechanical obstruction being the most frequent cause. Case report An 81-year-old man with a history of shunt system placement presented among clinical data of shunt dysfunction. The brain Computed Tomography (CT) showed dilation of the ventricular system, with no other associated injury. The cause of the dysfunction was a SAH determined by a lumbar puncture (LP) study. We performed an angiography reporting 3 aneurysms. Discussion The risk of shunt dysfunction at one year is 40% and at two years, the risk ups to 53% with obstruction of the system and infection being the two principal causes. The usefulness of a lumbar puncture for late detection of SAH lies in the red cells in the Cerebrospinal Fluid (CSF). When the CT is negative and the clinical suspicion remains, the lumbar puncture (LP) continues with higher sensitivity despite is over 12 hours of the onset clinic symptoms. Conclusion This case encourages to follow a rigorous protocol study for patients with multiple shunt dysfunction and chronic hydrocephalus. Also, this case invites to consider a hidden SAH secondary to a vascular pathology as a differential diagnosis for a multiple shunt dysfunction. Highlights • The principal causes of shunt dysfunction are obstruction and infection. • Lumbar puncture in the firsts days has 100% sensitivity for Subarachnoid Hemorrhage. • Negative image for Subarachnoid Hemorrhage can be positive in Lumbar Puncture. |
| Databáze: | OpenAIRE |
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