Sensitivity of papilledema as a sign of shunt failure in children

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Sayeda Nazir1, Mark O'Brien, Nazer H Qureshi

  • 1Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|November 22, 2008
PubMed

Insights

Papilledema is an unreliable indicator of shunt failure in children. Many children with shunt malfunction and high intracranial pressure show normal optic disks, meaning a normal exam doesn't rule out shunt issues.

Area of Science:

  • Pediatric Ophthalmology
  • Neurosurgery
  • Hydrocephalus Management

Background:

  • Papilledema is a recognized sign of shunt failure.
  • The sensitivity of papilledema in pediatric shunt malfunction is not well-established.

Purpose of the Study:

  • To determine the sensitivity of papilledema as an indicator of shunt failure in children.
  • To investigate the prevalence of papilledema in pediatric shunt malfunction.

Main Methods:

  • Prospective evaluation of 29 children (<19 years) with confirmed shunt malfunction.
  • Fundus examination and/or RetCam photography before shunt repair.
  • Intracranial pressure measurement during surgery.

Main Results:

  • Only 14% (4/29) of patients with shunt failure exhibited papilledema.
  • One patient had severe optic disk pallor; 24 had flat optic disks.
  • Five patients with elevated intracranial pressure (>300 mm H2O) had flat optic disks.

Conclusions:

  • Papilledema is not a sensitive sign for detecting shunt failure in children.
  • Flat optic disks can be present even with severe intracranial pressure elevation.
  • A normal optic disk examination does not exclude shunt malfunction in pediatric patients.
Abstract

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