Hydrocephalus is a condition defined by the excessive accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain, often referred to as “water on the brain.” This buildup increases pressure on the brain tissues, which can cause damage if not properly managed. The most common treatment involves the surgical placement of a shunt system, a fine tube that redirects the excess CSF to another area of the body, usually the abdomen, where it can be absorbed. While shunts successfully manage the condition, the system is a mechanical device that requires vigilance, making it necessary to understand actions and inactions that could compromise health and the device’s function.
Ignoring Critical Warning Signs
The biggest mistake a person with a shunt can make is dismissing the signs of a malfunction or infection, which demand immediate medical attention. Symptoms of a shunt problem arise when the device fails to drain CSF effectively, leading to a recurrence of increased intracranial pressure (ICP). These signs can vary significantly depending on the age of the person.
In infants, whose skull bones have not yet fused, a shunt malfunction may present as a rapid increase in head circumference, a bulging or tense soft spot (fontanelle), or a downward gaze of the eyes (“sun-setting”). Other signs in babies include unusual irritability, high-pitched crying, or recurrent, unexplained vomiting. Any of these signs should prompt an immediate consultation with a neurosurgeon or a visit to the emergency room.
For older children and adults, the symptoms tend to be more focused on the head and neurological function. The most common indicators of a shunt issue include a severe headache, nausea, and vomiting. Other serious changes can include excessive sleepiness (lethargy), vision problems such as double or blurred vision, or a noticeable decline in school or work performance.
Signs of a shunt infection, which is a serious complication, include a fever of 101°F or higher, redness, tenderness, or swelling along the path of the shunt tubing or at the incision site. If any of these signs appear, it is imperative to seek immediate specialized care, as a delay in treatment for a shunt problem can lead to severe neurological deterioration.
Actions That Risk Shunt Damage
A person with a shunt should avoid activities that pose a direct, forceful risk to the implanted system, particularly those involving high-impact head or abdominal trauma. Contact sports such as football, boxing, rugby, and wrestling are generally discouraged by physicians due to the potential for direct impact that could damage the shunt components or cause an internal head injury. Even a minor blow to the head or abdomen, where the distal catheter often resides, should be monitored closely for any subsequent symptoms of malfunction.
Activities that involve rapid, prolonged changes in body position should also be approached with caution, as they can affect the shunt’s drainage mechanics. Hanging upside down for an extended period is generally not advised because the shunt is designed to drain fluid with the assistance of gravity. For individuals with a lumbar-peritoneal (LP) shunt, activities that involve excessive twisting at the waist, such as some forms of martial arts or gymnastics, should be avoided as they can potentially dislodge the catheter.
Caution is also necessary regarding strong magnetic fields, particularly for those with a programmable shunt. Programmable valves may be unintentionally altered by strong magnets, such as those found in certain electric hair clippers or Magnetic Resonance Imaging (MRI) machines. Anyone with a programmable shunt must inform medical staff before an MRI or similar procedure to ensure the device’s settings are checked and protected or reset afterward.
Mistakes in Daily Management
Failing to maintain regular neurosurgical follow-up appointments is a mistake in long-term management. Even when the patient feels completely well, routine check-ups and imaging scans are necessary to monitor the shunt’s function and the size of the brain’s ventricles over time. Neglecting this preventative surveillance compromises the ability to detect subtle, chronic issues before they become acute emergencies.
Certain physiological factors, if left unmanaged, can temporarily increase intracranial pressure and cause uncomfortable symptoms, making it a mistake to ignore factors like severe constipation or dehydration. Dehydration can lead to headaches and fatigue, while straining from constipation can raise abdominal pressure, which may impede the shunt’s drainage into the peritoneal cavity. Maintaining adequate hydration and a diet that promotes regular bowel movements is an important part of daily management.
Proper hygiene and careful medication management are critical preventative measures. It is important to avoid creating open wounds or picking at scabs near the shunt track, as the shunt material is susceptible to infection, which bacteria readily colonize. Additionally, any changes to existing medications, especially those affecting blood clotting, should be discussed with the neurosurgeon, as certain drugs can increase the risk of complications without proper guidance.