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:
- 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)