0:01

Here is a patient who was discharged

0:04

on November 11th with this MRI scan.

0:07

After a revision of the ventriculostomy

0:12

catheter, you see the high signal intensity in

0:15

the scalp of edema from that surgical revision.

0:19

This is the reservoir of the ventriculostomy

0:22

catheter, and we see the catheter coursing

0:25

from the right frontal region into the

0:28

lateral ventricular system, crossing the midline to

0:30

get into the left lateral ventricle. And this is

0:33

the baseline imaging after revision of the shunt.

0:38

Two weeks later, the patient has fever,

0:41

lethargy, and is not eating well.

0:43

The mom brings the patient in. Here,

0:46

we can see the follow-up examination.

0:48

We notice the change in the ventricular size,

0:52

that this is much larger compared to the

0:54

contralateral side. The position of the catheter

0:57

is approximately the same, and what one often sees

1:01

in patients who have shunt failure is that the

1:04

fluid collection at the reservoir has expanded.

1:08

Normally, it would be flat, and there

1:09

wouldn't be fluid under the scalp.

1:11

In this case, the patient has had shunt failure,

1:15

and you get a larger CSFoma in the scalp region,

1:20

secondary to the shunt malfunction.

1:23

So this comparison study—again,

1:25

this is a T2-weighted scan.

1:27

It's a HASTE image.

1:28

You see we do it in the axial plane, as well as the

1:31

sagittal plane and the coronal plane.

1:35

These three sequences take about three minutes total to

1:41

perform, analogous to a CT scan but without radiation.

1:45

And we compare that with the follow-up examination,

1:48

where you have the enlargement of the

1:50

lateral ventricles. It's very nice

1:52

and eliminates the need for radiation.

1:56

Uh, it's been said that patients who

1:58

have ventriculostomies placed

2:02

as a child, on average, have about 25 studies

2:06

performed in their lifetime to check for ventricular

2:10

size because every time they get sick, have

2:13

lethargy, or have failure to thrive, the parents are

2:17

worried about the possibility of a shunt failure,

2:19

and they bring the patient into the emergency room.

2:22

Imagine the cumulative effect of that radiation if

2:25

we are doing CT scans again and again and again

2:29

of the patient's head.

2:31

If we are doing CTs to evaluate for shunt

2:33

failure. So now we use fast HASTE imaging on an MRI

2:38

scan. In this case—new lethargy, shunt failure.

Case: Shunt Failure

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