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Eosinophilia of the cerebrospinal fluid: late reaction to a silastic shunt
1Pediatric Neurology, John Hopkins Hospital, Baltimore, MD 21205.
Abstract:
The differential diagnosis of CSF eosinophilia consists primarily of infection, infestation or malignancy. This report describes an eight-year-old patient with a ventriculoperitoneal shunt who presented with a two-year history of episodic headache and vomiting and persistent tenderness of the skin overlying the bulb of the shunt. Ventricular CSF showed persisting eosinophilia, but there was no evidence of infection or malignancy. All abnormalities resolved promptly after the shunt was replaced.
Insights
Ventriculoperitoneal shunt malfunction can cause cerebrospinal fluid (CSF) eosinophilia, presenting as headache and vomiting. Replacing the shunt resolved all symptoms, indicating it as a potential cause of persistent CSF eosinophilia.
Area of Science:
- Neurology
- Neurosurgery
- Pediatrics
Background:
- Cerebrospinal fluid (CSF) eosinophilia is a rare finding with a differential diagnosis including infection, infestation, and malignancy.
- Ventriculoperitoneal shunts are commonly used to treat hydrocephalus, but can be associated with complications.
Observation:
- An eight-year-old patient with a ventriculoperitoneal shunt presented with a two-year history of episodic headache, vomiting, and localized shunt tenderness.
- Ventricular CSF analysis revealed persistent eosinophilia, with no evidence of infectious or malignant etiologies.
Findings:
- The patient's persistent CSF eosinophilia and associated symptoms were attributed to the ventriculoperitoneal shunt.
- Prompt resolution of all symptoms and CSF eosinophilia occurred after the shunt was surgically replaced.
Implications:
- This case highlights shunt malfunction as a potential, often overlooked, cause of CSF eosinophilia in patients with ventriculoperitoneal shunts.
- Considering shunt integrity in the differential diagnosis of unexplained CSF eosinophilia can lead to timely and effective management, particularly in pediatric neurosurgical cases.