Table 3 Clinical and MRI findings of symptomatic patients
From: MRI as a one-stop destination for evaluation of CSF shunt malfunction
Patient | Age | Indications for shunting | Location of the shunt complication | Management | Cranial end | Abdominal end | Ventricular dilatation | White matter abnormal signal | Phase contrast (flux/mean velocity)(ml/sec and cm/sec) |
|---|---|---|---|---|---|---|---|---|---|
1 | 4.5 Y | Post-meningoencephalitis | No shunt-related abnormality | Insertion of an additional shunt in the entrapped CSF pocket | Patent | Minimal free fluid | Dilated with internal loculations and entrapped CSF pockets | Present | 0.01/0.5 |
2 | 1.25 Y | Post-meningoencephalitis | No shunt-related abnormality | Conservative | Patent | Minimal free fluid | Dilated | Absent | Â |
3 | 7Â M | Post-meningoencephalitis | No shunt-related abnormality | Conservative | Patent | Minimal free fluid | Dilated | Absent | 0.01/0.24 |
4 (had three shunts) (Fig. 8) | 27 Y | Post-meningoencephalitis | The recent shunt had no related abnormality | Conservative | Patent* | Minimal free fluid | Dilated | Absent |  |
Patent with proximal catheter disconnection | |||||||||
Intraluminal faint low signal with distal catheter disconnection | |||||||||
5 | 27 Y | Post-meningoencephalitis | Cranial end | Shunt revision | Intraluminal low signal with distal catheter disconnection | Minimal free fluid | Dilated | Absent | 0.01/0.01 |
6 (Fig. 3) | 2 M | Congenital hydrocephalus | Cranial end | Shunt revision | Intraluminal low signal | Minimal free fluid | Dilated with fine internal septae surrounding the shunt | Absent | 0.01/0.2 |
7 (Fig. 7 A) | 15 Y | Idiopathic communicating hydrocephalus | Cranial end | Shunt revision | Intraluminal dark signal, was close to the choroid plexus | Minimal free fluid | Dilated | Absent | 0.005/0.25 |
8 (Fig. 7 B) | 24 Y | post-meningoencephalitis | Cranial end | Insertion of an additional shunt | Intraluminal dark signal | Minimal free fluid | Dilated with fine internal septae surrounding the shunt | Present |  |
9 | 65 Y | Multiple brain metastasis | Cranial end | Conservative | Intraluminal dark signal, was close to the choroid plexus | Minimal free fluid | Not dilated | Present | 0.01/0.16 |
10 (Fig. 9 A) | 9 M | post-meningoencephalitis | Cranial end | Shunt revision | Extraventricular | Minimal free fluid | Dilated with internal loculations | Absent |  |
11 (Fig. 10) | 9 M | Congenital hydrocephalus | Cranial end | Shunt revision | Patent with fluid collection surrounding the reservoir | Minimal free fluid | Dilated with ventricular diverticulum | Absent | 0.1/2.2 |
12 | 7 Y | Congenital hydrocephalus | Cranial end | Conservative | Patent | Minimal free fluid | Slit-like ventricles suggesting overshunting | Absent | 0.01/0.23 |
13# (had two shunt) (Fig. 9 B) | 36 Y | Posterior fossa neoplasm | Cranial and abdominal end | Shunt revision | *Intraluminal low signal, was close to the choroid plexus | Extraperitoneal migration | Not dilated | Present |  |
Intraluminal dark signal, was embedded within septum pellucidum | No peritoneal fluid | ||||||||
14 | 3 Y | Congenital hydrocephalus | Cranial and abdominal end | Shunt revision | Intraluminal low signal, was embedded within choroid plexus | CSF pseudocyst complicated with abdominal wall sinus | Not dilated | Absent | Â |
15 | 1.25 Y | post-meningoencephalitis | Abdominal end | Shunt revision | Patent | CSF pseudocyst | Dilated | Present | 0.02/0.38 |
16## (Fig. 5) | 2 Y | Congenital hydrocephalus | Abdominal end | Shunt revision | Patent | CSF pseudocyst | Dilated with fine internal septae | Present | 0.08/2.2 |
17 (had two shunts)** | 41 Y | Congenital hydrocephalus | Abdominal end | Shunt revision and omental plugging confirmed at surgery | Patent | No peritoneal fluid | Dilated | Present | 0.1/1.7 |