Which sign is most indicative of shunt malfunction in a child with hydrocephalus after shunt revision?

Which sign is most indicative of shunt malfunction in a child with hydrocephalus after shunt revision?

• A. Fever
• B. Personality change
• C. Bulging anterior fontanel
• D. Dizziness

Answer: (A)

When a shunt isn’t draining properly, intracranial pressure rises, and the most telling sign in an infant is a bulging anterior fontanel. The fontanel is open in infancy, so elevated pressure pushes it outward, providing a visible clue that the brain is under pressure from accumulating CSF. In older children, you’d look for classic raised-ICP symptoms like headache, vomiting, and lethargy. Fever points more toward infection of the shunt system rather than a mechanical malfunction or underdrainage itself. While infection can accompany shunt problems, fever alone is not the most direct or sensitive indicator of a malfunction. Other signs like personality changes or dizziness can occur but are less specific to shunt failure in this context. The key distinction is that bulging fontanelle specifically signals increased intracranial pressure due to malfunction in infants, making it the most indicative sign. If fever is present, evaluate for shunt infection as well, but don’t rely on fever alone to diagnose malfunction.

When a shunt isn’t draining properly, intracranial pressure rises, and the most telling sign in an infant is a bulging anterior fontanel. The fontanel is open in infancy, so elevated pressure pushes it outward, providing a visible clue that the brain is under pressure from accumulating CSF. In older children, you’d look for classic raised-ICP symptoms like headache, vomiting, and lethargy.

Fever points more toward infection of the shunt system rather than a mechanical malfunction or underdrainage itself. While infection can accompany shunt problems, fever alone is not the most direct or sensitive indicator of a malfunction. Other signs like personality changes or dizziness can occur but are less specific to shunt failure in this context. The key distinction is that bulging fontanelle specifically signals increased intracranial pressure due to malfunction in infants, making it the most indicative sign. If fever is present, evaluate for shunt infection as well, but don’t rely on fever alone to diagnose malfunction.