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Trouble shooting Neurosurgical Shunt for Malfunction

Shunt malfunction may occur at ANY TIME after shunt placement with the risk of malfunction being the highest in the first 6 weeks post shunt surgery. Patient's symptoms are usually progressive, rarely intermittent. Distal malfunctions may be less acute.


Children strongly suspected of or known to have a shunt malfunction and appears to be in pain should NOT be given narcotics, as it may decrease their respiratory drive leading to respiratory arrest and/or herniation. For pain control provide non-narcotic or non-sedating medications.


Symptoms of shunt malfunction:   

  1. HA
  2. Vomiting 
  3. Lethargy
  4. New onset seizures (rare)


Possible signs of shunt malfunction:

  • Decreased arousal on exam
  • Full, taut or bulging fontanelle in neonate/infant

"sundowning" (downward fixed gaze)