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E. Dale Everett, Theodore C. Eickhoff and Richard H. Simon

. Shurtleff DB , Foltz EL , Weeks RD , et al : Therapy of Staphylococcus epidermidis: infections associated with cerebrospinal fluid shunts. Pediatrics 53 : 55 – 68 , 1974 Shurtleff DB, Foltz EL, Weeks RD, et al: Therapy of Staphylococcus epidermidis: infections associated with cerebrospinal fluid shunts. Pediatrics 53: 55–68, 1974 14. Stauffer UG : “Shunt nephritis:” diffuse glomerulonephritis complicating ventriculoatrial shunts. Dev Med Child Neurol [Suppl] 22 : 161 – 164 , 1970 Stauffer UG

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Thomas R. Keucher and John Mealey Jr.

greatly increased morbidity, requiring prolonged hospitalizations and an average of more than twice as many shunt revisions (4.34 revisions for infected cases versus 1.74 revisions for noninfected patients (p < 0.001)). Other Complications Three patients with low-grade staphylococcal infections of their VA shunts had recurrent bacteremias and ultimately developed “shunt nephritis.” 38 One child died, and the other two have suffered permanent compromise in their renal function. In two of these patients, staphylococcal infections were diagnosed by blood culture

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Diphtheroid infections of cerebrospinal fluid shunts

The changing pattern of shunt infection in Cleveland

Harold L. Rekate, Teresa Ruch and Frank E. Nulsen

been reports of other diphtheroid species causing blocked shunts or disease, including shunt nephritis and even ventriculitis. 2–4, 6, 13 The shunt nephritis caused by diphtheroids is probably on an immune complex basis. Renal biopsies on affected patients have shown proliferation of mesangial cells and matrix plus subendothelial and mesangial deposits. Immunofluorescence has been positive for immunoglobulins (Ig) and complement in a granular pattern along the glomerular basement membrane. 7, 9 Our one case of diphtheroid shunt nephritis was in a patient with a

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55 1 89 98 10.3171/jns.1981.55.1.0089 Shunt nephritis Robert J. Wyatt John W. Walsh Nancy H. Holland July 1981 55 1 99 107 10.3171/jns.1981.55.1.0099 Anterior decompression for ossification of the posterior longitudinal ligament of the cervical spine Hiroshi Abe Mitsuo Tsuru Terufumi Ito Yoshinobu Iwasaki Mitsuyuki Koiwa July 1981 55 1 108 116 10.3171/jns.1981.55.1.0108 Intradural disc rupture Richard V. Smith July 1981 55 1 117 120 10.3171/jns.1981.55.1.0117 Infarction of the spinal cord as a complication of pneumococcal meningitis Helen M. Haupt

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Shunt nephritis

Role of the complement system in its pathogenesis and management

Robert J. Wyatt, John W. Walsh and Nancy H. Holland

leads to recovery. Persistent nephritis, however, can cause irreversible renal parenchymal damage. This paper reports the value of serial determinations of serum levels of individual complement proteins as a method of assessing the efficacy of and response to treatment. Three cases in which such serial determinations of the level of one or more complement proteins were obtained will be presented. Materials and Methods Case Selection The medical records of three patients with shunt nephritis treated at the University of Kentucky Medical Center between 1965

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Peter T. Frame and Robert L. McLaurin

urinary tract evaluation. At the time of admission she had a functioning VJ shunt in place, as well as a free floating catheter in the opposite lateral ventricle left behind from a previous shunt. While in the hospital she developed high fever and had positive blood and CSF cultures for Pseudomonas cepacia . The ventricular fluid also grew Staphylococcus epidermidis . The patient also had shunt nephritis with proteinuria, hematuria, and evidence of circulating immune complexes. Her most recent shunt surgery had been 2 years previously, in which time Ps. cepacia was

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Michael J. Noetzel and Roy P. Baker

Fourteen cases of shunt-related infection were documented in our patient population. In the three instances in which a VA shunt was involved, the clinical and laboratory features were consistent with “shunt nephritis” as a consequence of chronic shunt colonization with Staphylococcus epidermidis . Infection of VP shunts presented either as meningitis and ventriculitis (nine cases) or localized abdominal infections (two cases). In one instance of meningitis, the diagnosis was established by culture of CSF obtained at lumbar puncture. In that patient, shunt fluid was

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Paul J. Camarata, Robert E. McGeachie and Stephen J. Haines

subdural fluid infection, 6 intracerebral abscess, 29 and immune complex-mediated shunt nephritis. 13 These are the first cases suggesting a role of P. acnes in the pathogenesis of a midbrain inflammatory process. P. acnes has been incriminated in the pathogenesis of CSF shunt infections. 3, 11–13, 27, 34, 35 The actual number of infections caused by these bacteria is probably greater than reported for several reasons. First, the organism often goes undetected in routine aerobic CSF cultures because it is a fastidious anaerobe. 35 Unless specimens are routinely

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. Rapoport April 1991 74 4 643 649 10.3171/jns.1991.74.4.0643 Hemifacial spasm caused by a spontaneous dissecting aneurysm of the vertebral artery Kengo Matsumoto Toshikazu Saijo Hideyuki Kuyama Shoji Asari Akira Nishimoto April 1991 74 4 650 652 10.3171/jns.1991.74.4.0650 Postoperative ectopic craniopharyngioma Ashvin T. Ragoowansi David G. Piepgras April 1991 74 4 653 655 10.3171/jns.1991.74.4.0653 Shunt nephritis Stephanie Rifkinson-Mann Nathan Rifkinson Terence Leong April 1991 74 4

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Shunt nephritis

Case report

Stephanie Rifkinson-Mann, Nathan Rifkinson and Terence Leong

B ecause many children with ventricular shunts placed for hydrocephalus also have myelomen-ingocele with subsequent neurogenic bladder, urinary stasis and reflux are considered to be the primary mechanism by which these patients develop renal infection. However, an uncommon though serious complication of infected ventricular shunts is glomerulonephritis which, if untreated, can be fatal. 11, 12, 18 Shunt nephritis is usually associated with ventriculoatrial (VA) or ventriculovascular shunts, but two cases stemming from ventriculoperitoneal (VP) systems have