Hydrocephalus Medical Alert

Shunts and Endoscopic Third Ventriculostomies (ETV) can malfunction for a number of reasons. Acute blockages can be life threatening. It is important to be vigilant and aware of the protocol to follow if you suspect a shunt malfunction. You will need access to contact numbers for the person’s neurosurgery team, if they are under the care of one, and GP.

 

Signs of shunt malfunction: Think shunt!

Emergency symptoms or signs to look for may include some, or all of the following:

  • Drowsiness / confusion
  • Vomiting / extreme nausea
  • Photophobia / sensitivity to light
  • Visual disturbances
  • Severe headaches

If you notice any of the symptoms listed, think shunt!

 

What to do if you see these signs

  1. Check shunt alert card - for details of the neurosurgical centre and call them for advice.
  2. Be ready to call 999... if you cannot contact the neurosurgical centre. If they are losing consciousness, call an ambulance immediately (999).

 

Chronic Symptoms

Chronic symptoms may develop over weeks or even months. Symptoms that should be reviewed at a neurosurgery centre include:

  • Fatigue
  • Behaviour changes
  • General malaise
  • Decline in academic performance
  • Visual problems
  • Being “not right”

If a person with hydrocephalus has any of these symptoms, do not assume that someone else has noticed. Contact the neurosurgery department or discuss with the GP. Notify the Next of Kin if appropriate. Be ready to attend A&E if the person’s condition deteriorates or they begin to lose consciousness. You should inform the next of kin immediately.

 

Health and Safety Alerts

People with hydrocephalus can do most activities safely, although extra care should be taken in the following situations:

Magnets

Many common household and technological items contain magnets which may affect certain shunt valves if in direct contact. There are several makes and models of shunts, all with different features. It is important to have a record of the type of shunt. Fixed pressure valves cannot be altered, and no additional precautions are needed around magnets. Programmable valves require a magnetic device to alter the setting, and some, but not all, may possibly be unintentionally changed by magnets in the environment, if placed very close/ directly over the valve. Very strong magnets, such as in MRIs or audiology equipment, may also change the setting. Some programmable valves have features which make it difficult to change the setting without specialist equipment, so don’t need any precautions. This information becomes very important if hearing tests or aids are needed, or MRI is planned other than in the neurosurgery unit.

 

Hydration

It is important that people with hydrocephalus do not become dehydrated as it can cause fatigue, headaches and behaviour changes. It is recommended that most people drink around 1.5-2 litres of water per day, spaced throughout the day. People with hydrocephalus may need prompting or reminding to drink, even if the water is within their reach.

 

Technology

Always conduct a safety assessment for handling tools and equipment. If in doubt, seek advice from the person’s neurosurgeon or one of Shine’s health specialists.

 

Getting around...

Some people with hydrocephalus have difficulty finding their way. Do not assume that a route has been memorised and can be recalled. People who have difficulty judging speed and distance must be supervised when crossing roads.

 

Sports alerts

Physical activity has huge benefits for anyone with hydrocephalus as it can help to “reprogram” the brain through repetition and positive feedback. There are very few sports that are not advisable, but you should always communicate with a person’s emergency contact before starting a new activity programme.

  • Swimming is a beneficial, although people with epilepsy may need close supervision.
  • Activities such as running, trampolining, forward rolls and using gym equipment should be safe. People with shunts should not hang upside down for any length of time as the shunt will not drain in this position.
  • If a person has a lumbar peritoneal (LP) shunt, sports involving twisting of the lumbar region of the back may not be advisable, e.g. gymnastics, aerobics, golf or ballet.
  • Some people may find sports that require good visual perception and spatial awareness challenging. Team sports requiring quick and accurate responses, e.g. close-fielding positions in cricket or rounders, may be difficult if the person has visual perception difficulties.
  • Care should be taken with contact sports or certain martial arts, as well as any activity where someone is grabbed around the neck, as shunt tubing can become fractured.
  • Advice should be sought from a neurosurgeon before partaking in contact sports.

 

Watch out! If someone is hit hard in the head during any activities (e.g. struck by a ball) then watch out for signs of shunt malfunction.