Document Detail


Ventricular enlargement due to acute hypernatremia in a patient with a ventriculoperitoneal shunt.
MedLine Citation:
PMID:  19911884     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients requiring CSF shunts frequently have comorbidities that can influence water and electrolyte balances. The authors report on a case involving a ventriculoperitoneal shunt in a patient who underwent intravenous hyperhydration and withdrawal of vasopressin substitution prior to scheduled high-dose chemotherapy regimen for a metastatic suprasellar germinoma. After acute neurological deterioration, the patient underwent CT scanning that demonstrated ventriculomegaly. A shunt tap revealed no flow and negative opening pressure. Due to suspicion of proximal shunt malfunction, the comatose patient underwent immediate surgical exploration of the ventricle catheter, which was found to be patent. However, acute severe hypernatremia was diagnosed during the procedure. After correction of the electrolyte disturbances, the patient regained consciousness and made a good recovery. Although rare, the effects of acute severe hypernatremia on brain volume and ventricular size should be considered in the differential diagnosis of ventriculoperitoneal shunt failure.
Authors:
Robert H Andres; Arjun V Pendharkar; Dominique Kuhlen; Luigi Mariani
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  113     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-02     Completed Date:  2010-07-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  82-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurosurgery, Stanford University Medical Center, Stanford, California 94305, USA. randres@stanford.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Antidiuretic Agents / administration & dosage,  adverse effects*
Antineoplastic Agents / administration & dosage
Astrocytoma / complications,  drug therapy,  radiotherapy
Brain Stem Neoplasms / complications,  drug therapy,  radiotherapy
Cerebral Ventricles / pathology*
Chemotherapy, Adjuvant
Cranial Irradiation
Deamino Arginine Vasopressin / administration & dosage,  adverse effects*
Diagnosis, Differential
Diagnostic Errors
Equipment Failure Analysis
Fluid Therapy / adverse effects*
Humans
Hydrocephalus / etiology,  surgery*
Hypernatremia / complications*,  diagnosis
Hypertrophy
Male
Neoplasms, Multiple Primary / drug therapy,  radiotherapy
Pituitary Neoplasms / complications,  drug therapy,  radiotherapy
Postoperative Complications / diagnosis,  etiology*,  surgery*
Substance Withdrawal Syndrome / diagnosis,  etiology*
Tectum Mesencephali
Tomography, X-Ray Computed*
Ventriculoperitoneal Shunt*
Chemical
Reg. No./Substance:
0/Antidiuretic Agents; 0/Antineoplastic Agents; 16679-58-6/Deamino Arginine Vasopressin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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