Intravenöse Dislokation eines ventrikuloatrialen Shunts - Fallbereicht

Complications associated with VA shunt-insertion are infections, tromboembolic complications, catheter dislocation, exacerbation of pulmonary hypertension, and nephritis. We present the case of a 24-year-old patient with spontaneous intravenous dislocation of the atrial catheter after surgery 11 months prior.

A 24-year-old male patient presented with acute symptoms of increased intracranial pressure with less than 24 hours of onset. The patient´s medical history includes a neonatal posthemorrhagic hydrocephalus with immediate shunt insertion as a newborn. Over the past years, several revision surgeries were performed including aqueductoplasty and placement of a stent as well as various revisions of the shunt-system. In 01/2022, VA-shunt implantation was performed. The patient remained in regular clinical control with no signs of shunt-dysfunction. The last x-ray in 09/2022 revealed a regular position of the catheters. Unusual activities or body movements in the days prior to admission were not reported.

The patient was suffering from severe and increasing headaches without new neurological deficits. The cranial CT-scan showed an enlargement of the ventricles compared to prior images. The radiographs of head and chest revealed a dislocation of the atrial catheter. For further evaluation, a CT scan of the neck was performed that showed a double flexion of the distal catheter inside the (intern jugular) vein, turning up and into cranial direction with another flexion back into caudal direction at the jaw angle. Revision surgery with placement of a new atrial catheter was performed with an uneventful postoperative course and correct placement of the catheter.

Intravenous dislocation of a VA shunt is a rare complication. An intravenous flexion in cranial direction has not been reported so far. The underlying pathophysiological mechanism remains unknown, but it might be attributed to implantation of the catheter into a big vein giving the catheter space to be able move to within the vessel presumably due to changes in the central venous pressure and/or intracranial pressure.