Hydrocephalus and Shunts – What you Need to Know

Whilst cases of hydrocephalus can be managed by fitting a shunt or Endoscopic Third Ventriculostomy (ETV), these can and do go wrong.

Our useful guidance compiled below contains general health and safety tips, how to spot whether a problem has developed and what action to take if you suspect shunt malfunction or similar has occurred.

• Medical Alert

• Shunt malfunction protocol

• Chronic symptoms

• Health and Safety

• Sports Alerts

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Medical Alert

Shunts and Endoscopic Third Ventriculostomies (ETV) can malfunction for a number of reasons.

Acute blockages can be life-threatening. Everyone should be vigilant and aware of the protocol to follow if they suspect a shunt malfunction.

You will need easy access to home, work and mobile phone numbers for the person's specified emergency contact or next of kin.

Shunt Malfunction Protocol

Emergency symptoms or signs to look for may include some, or all of the following:

• Drowsiness / confusion
• Vomiting / extreme nausea
• Photophobia / sensitivity to light
• Visual disturbances
• Severe headaches

If you notice any of the symptoms listed:

 

Next of kin should:

1. Contact the hospital A & E department
2. Speak directly to the Neurosurgery ward sister or neurosurgery registrar
3. In acute shunt malfunction, the person needs to be seen at a neurosurgical unit within four hours.

Staff may need to carry out steps 1 and 2 if unable to contact the next of kin.

Chronic symptoms

Chronic symptoms may develop over weeks or even months. Symptoms that should be reviewed at a neurosurgery centre include:

• Fatigue
• Behaviour changes
• General malaise
• Decline in academic performance
• Visual problems
• Being "not right"

If a person with hydrocephalus has any of these symptoms, do not assume someone else has noticed. You should inform the next of kin immediately.

Health and safety alerts

People with hydrocephalus can do most activities. Care should be taken in the following situations.

Magnets

Fixed pressure valves will not be affected by magnets. Certain programmable (adjustable) valves, such as ProGAV, PaediGAV, or Codman Certas Plus are designed so that they cannot be accidentally reset by magnetic fields. However, some types of programmable shunts may potentially be reset by magnets.

It is important to know what type has been used, particularly with children, in case extra supervision is needed around magnets, to prevent them from being placed near to the valve.

Some electric hair clippers use an electromagnetic field and should be avoided in people with those programmable shunts which may be unintentionally reset. If someone with a programmable shunt becomes unwell, follow the Shunt Malfunction Protocol. 

Hydration 

It is important that people with hydrocephalus do not become dehydrated as it can cause fatigue, headache and behaviour changes. It is recommended that they drink a small glass of water approximately every hour. If the person is noticeably more tired in the afternoons, check their water intake.

Technology

People with hydrocephalus should have a safety assessment for handling tools and equipment. If in doubt, seek advice from the person’s neurosurgeon or Shine’s health specialists.

Navigation

Some people with hydrocephalus have difficulty finding their way. Do not assume that a route has been memorised and can be recalled. People who have difficulty judging speed and distance will need assistance when crossing roads.

Sports Alert

Physical activity has huge benefits for anyone with hydrocephalus as it can help to “reprogram” the brain through repetition and positive feedback. There are very few sports that are not advisable, but you should always communicate with the person’s next of kin before starting a new activity programme.

• Swimming is a recommended sport, although people with epilepsy may need close supervision
• People can run, jump, trampoline, do forward rolls and use gym apparatus. They may need help with balancing activities. They should not hang upside down for any length of time as the shunt will not drain in this position.
• If a person has a lumbar peritoneal (LP) shunt, sports involving twisting of the lumbar region may not be advisable, e.g. gymnastics, aerobics, golf or ballet.
• Some people may find sports that require good visual perception and spatial awareness challenging. Team sports requiring quick and accurate responses, e.g. close-fielding positions in cricket or rounders may be difficult if the person has visual perception difficulties.
• Care should be taken with contact sports or certain martial arts, as well as any activity where a person is grabbed around the neck, as shunt tubing can become fractured
• Advice should be sought from a neurosurgeon before partaking in contact sports.

 

 

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