Bilateral Proptosis in a Child-A Rare Manifestation of Ventriculoperitoneal Shunt Obstruction

Abstract

Ventriculoperitoneal shunt (VPS) obstruction may have a myriad of presentations. We reported a case of an 11-year-old girl presenting with acute, bilateral proptosis secondary to VPS obstruction. While neuroimaging was interpreted as unremarkable, fundoscopy revealed bilateral papilledema and lumbar puncture showed elevated intracranial pressure. Neurosurgical exploration demonstrated VPS valve obstruction and a new VPS was inserted. Postoperatively, she developed a recurrent extradural hematoma, which was initially evacuated and later managed conservatively. To our knowledge, this is the first report of bilateral proptosis secondary to VPS obstruction. This case highlights the value of key clinical findings and limitations of neuroimaging.

Keywords: obstruction; proptosis; ventriculoperitoneal shunt.

Fig. 1

Axial T2-weighted magnetic resonance imaging scans of the brain and orbits obtained on admission demonstrate ( A ) a left parieto-occipital ventriculoperitoneal shunt in situ, with no evidence of hydrocephalus, space-occupying lesions, or mass effect. ( B ) Of note, there is increased perioptic nerve cerebrospinal fluid space and posterior globe indentation from the optic nerve sheaths, suggestive of intracranial hypertension.

Fig. 2

Coronal ( A ) and axial ( B ) T1-weighted magnetic resonance imaging scans of the brain obtained 1 week after surgical placement of a new left frontal ventriculoperitoneal shunt demonstrate a right extradural hematoma indenting the right cerebral hemisphere with midline shift to the left.