6.2.2\ Shunt-Associated Intracranial

Hemorrhage

6.2.2.1\ Discussion

Intraparenchymal, subdural, and intraventricular hemorrhage associated with placement of VP shunts is an uncommon complication, with an estimated incidence of 0.3–4% (Fig. 6.30). Intracranial hemorrhage may present soon after ventricular catheterization or it can be delayed. Predisposing factors include underlying parenchymal friability, venous occlusion, coagulopathy, multiple catheter passes, choroid plexus injury, and malpositioning near a vascular structure. Intraparenchymal hemorrhage associated

a

with VP shunting typically runs parallel to the length of the tubing and can be circumferential. Frequently, choroid plexus hemorrhage can lead to disseminated intraventricular hemorrhage and can contribute to shunt malfunction.

The development of chronic calcified subdural hematomas is a potential long-term complication of ventriculoperitoneal shunting. The calcifications tend to occur at the margins of the fluid collection (Fig. 6.31), but may sometimes be more confluent. When bilateral, these have been termed “armored brain.” Although the calcified subdural hematomas can produce symptoms, they generally do not require further intervention.

b

Fig. 6.30  Shunt-associated hemorrhage. Axial CT image (a) obtained 2 days following VP shunt placement shows a focus of right frontal lobe hemorrhage adjacent to the catheter (arrow). There is also hemorrhage within the

choroid plexus and the posterior horn of the right lateral ventricle (encircled). Axial CT image in a different patient (b) shows subdural hematomas (arrows) that formed shortly after shunt catheter insertion.