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Slitlike ventricle syndrome: a life-threatening presentation

Paulo Sérgio Lucas da Silva1, Italo Capraro Suriano, Henrique Monteiro Neto

  • 1Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal, São Paulo, Brazil. psls.nat@terra.com.br

Pediatric Emergency Care
|October 17, 2009
PubMed

Insights

Normal ventricular hydrocephalus, a severe form of slit ventricle syndrome, can be life-threatening in shunted children. Prompt recognition and shunt revision are crucial for managing intracranial hypertension without ventricular enlargement.

Area of Science:

  • Pediatric neurosurgery
  • Pediatric critical care

Background:

  • Shunted hydrocephalus is common in children with myelomeningocele.
  • Normal ventricular hydrocephalus (NVH) presents a diagnostic challenge in shunted patients.

Observation:

  • A 7-year-old girl with a shunt for myelomeningocele presented with severe symptoms of increased intracranial pressure.
  • Cranial CT scans showed slit-like ventricles, suggesting shunt patency, despite clinical deterioration.
  • Lumbar puncture revealed elevated cerebrospinal fluid pressure, contradicting CT findings.

Findings:

  • The patient's shunt catheter was found to be occluded and adhered to the ventricular wall.
  • Shunt revision led to dramatic neurological improvement.
  • NVH can cause severe intracranial hypertension without ventricular enlargement, potentially missed in emergency settings.

Implications:

  • Highlights the critical need to consider NVH in shunted children with unexplained neurological decline.
  • Emphasizes that normal or slit ventricles on imaging do not rule out shunt malfunction or intracranial hypertension.
  • Underscores the importance of clinical suspicion and invasive monitoring (e.g., lumbar puncture) in diagnosing NVH.
Abstract

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