Article
To scan or not to scan? The utility of CT in shunted patients with pseudotumor cerebri syndrome presenting to the emergency department
Die Wertigkeit der notfallmäßigen CT-Diagnostik bei shuntversorgten Patienten mit Pseudotumor cerebri Syndrom
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Authors
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Manolis Polemikos
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
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Elvis J. Hermann
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
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Hans E. Heissler
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
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Joachim Kurt Krauss
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Patients with pseudotumor cerebri syndrome (PCS) frequently present to the emergency department (ED) due to disease-related symptoms after ventriculoperitoneal shunting (VPS). Computed tomography (CT) rarely reveals new pathological findings but is frequently performed, mostly considering medicolegal aspects. In this study we evaluated the usefulness of CT in the management of shunted patients with PCS who presented to the ED.
Methods: All adult patients with PCS who were diagnosed and treated with VPS between 2005 and 2019 in our department were included. We excluded patients with PCS initially diagnosed and operated elsewhere but presented postoperatively to our ED. Every CT performed in the ED was compared with previous postoperative CTs and was analysed for pathological findings.
Results: 37 patients (29 women / 8 men) were diagnosed with PCS and treated with a VPS. All patients received a programmable valve; 34/37 with an integrated shunt assistant. 20/37 patients presented a total of 72 times in our ED. Most common symptoms were headaches (47 times) and visual disturbances (16 times). An ophthalmological consultation was conducted in 17/72 visits. 40 out of 42 CTs showed no pathognomonic changes when compared to previous available CTs. In 2 patients findings were suggestive for shunt infection and subsequently confirmed by MRI. Out of 42 ED visits with CT no change in the patient management was undertaken in 25 visits (54,3%); in 13 visits (28,2%) the opening pressure (OP) of the valve was altered and in 8 visits (17,4%) the patient was admitted for further treatment. In comparison, when no CT was performed management for the patient remained unchanged in 14 cases (53,8%), the valve OP was altered 5 times and 5 times findings led to admission (19,2%).
Conclusion: Our findings suggest that contrary to shunted hydrocephalus patients CT in shunted PCS patients in general, does not reveal signs of shunt malfunction or subdural hematomas. Therefore management of these patients can rather rely on clinical findings as long as visual deterioration or shunt infection is not concerned. CT should be reserved for after ophthalmological examination confirmed new or worsening of pre-existing findings.
