Ventriculoperitoneal Shunt Occlusion Resulting In Acute Hydrocephalus And Death In Developmentally-Delayed Patients: 2 Case Reports
The standard clinical strategy for managing conditions with chronic hydrocephalus involves the placement of a ventriculoperitoneal (VP) shunt. Failure of the shunt due to physical obstruction of the device is a recognized complication; however, the mortality associated with obstruction is poorly-defined. In this report, the authors describe two cases of death related to acute hydrocephalus resulting from obstruction of VP shunts.
CASE 1: A 23-year-old female cerebral palsy patient with a history of congenital hydrocephalus and VP shunt was found unresponsive and apneic at her group home, just three days after being hospitalized for "gastroenteritis." Despite initial successful resuscitation, she was pronounced braindead shortly after admission. Autopsy disclosed signs of acute hydrocephalus. Evaluation of the VP shunt revealed occlusion by soft, red-tan substance, which, on microscopic exam, was composed of fibrovascular tissue with chronic inflammatory cells.
CASE 2: A 15-year-old cerebral palsy patient, with a history of hydrocephalus with VP shunt, presented to an emergency department (ED) with complaints of progressively worsening headache and neck pain. Upon arrival at the ED, he experienced a seizure and became unresponsive. He was resuscitated, and despite urgent intervention, he died the next day. Autopsy revealed signs of acute hydrocephalus and a complete VP shunt obstruction.
Although VP shunt failure is relatively common, death related to such failure is relatively rare, or at least not well-described in the literature. The presented cases serve to highlight the importance of shunt evaluation at autopsy in cases of sudden, unexpected death in this vulnerable patient population.