Ventricular enlargement due to acute hypernatremia in a patient with a ventriculoperitoneal shunt

Case report

Robert H. Andres Department of Neurosurgery, Stanford University Medical Center, Stanford, California;
Department of Neurosurgery, University of Berne; and

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Arjun V. Pendharkar Department of Neurosurgery, Stanford University Medical Center, Stanford, California;

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Dominique Kuhlen Department of Neurosurgery, University of Berne; and

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Luigi Mariani Department of Neurosurgery, University of Berne; and
Department of Neurosurgery, University of Basel, Switzerland

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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.

Abbreviations used in this paper:

ICP = intracranial pressure; VP = ventriculoperitoneal.
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