Introduction: Shunt surveys and shunt patency studies can be performed in the emergency department to evaluate for shunt malfunction in patients with pseudotumor cerebri. Here, we examine the utility of these studies in this unique patient population.
Methods: The ED visits of all shunted patients with a diagnosis of PTC from 2003 to 2015 were retrospectively reviewed. Demographics, symptoms, PTC diagnosis and treatment history, imaging findings, and information regarding management changes were collected. ED visits not related to PTC were excluded from our study.
Results: Thirty-one patients visited the ED a total of 171 times for symptoms related to their PTC. Five patients had greater than 10 ED visits. Twenty-five (81%) patients had a total of 105 visits involving a shunt survey, with four (3.9%) showing problems with the catheter. Nine (29%) patients had a total of 10 visits involving a shunt patency study: five were normal, four were abnormal, and one was inconclusive. Of the 105 visits with a shunt survey, 17 (16%) resulted in a change in management as compared to 12 out of 66 (18%) visits without a shunt survey (p = 0.83). Of the 10 visits with shunt patency studies, 5 (50%) resulted in a change in management as compared to 24 (15%) out of 161 visits without a shunt patency study (p = 0.014).
Conclusions: Shunt surveys detected catheter pathology only 3.9% of the time, and there was no difference in the rate of management changes between those patients who underwent a shunt survey and those who did not. There was a significant difference in the rate of management changes in patients who received shunt patency studies as compared to those who did not. Shunt surveys may not be a sensitive tool to screen shunted pseudotumor patients in the ED.
Patient Care: This study helps to determine the utility of shunt surveys and shunt patency studies in the evaluation of patients with pseudotumor cerebri who present to the ED.
Learning Objectives: By the conclusion of this session, participants should be able to describe the utility of shunt surveys and shunt patency studies for patients with pseudotumor cerebri who present to the ED.