A 9-YEAR-OLD GIRL presented with a 5-day history of a mild frontal headache. She had undergone a craniotomy 1 year earlier for a right frontal and intraventricular low-grade astrocytoma. At surgery, a right ventricular shunt was placed for hydrocephalus. Two months postoperatively, the shunt-dependent child required shunt revision for a loculated right lateral ventricle. The patient was receiving no medications, had no recent history of trauma, and was doing well in school.
A follow-up magnetic resonance imaging (MRI) scan was obtained 2 weeks prior to presentation and demonstrated stable ventricular size. The study was degraded by a magnetic susceptibility artifact. Findings from physical examination were unremarkable. The patient was afebrile, vital signs were stable, and she was neurologically normal. The surgical incisions were well healed, and shunt tubing was palpable subcutaneously along the right lateral aspect of the neck; the right parietal shunt reservoir pumped and filled well.
Radiographs of the head and neck were obtained to evaluate the shunt and better define any surgical hardware that might have affected the MRI (Figure 1 and Figure 2). Radiographs were interpreted as showing discontinuity of the shunt at 2 locations. The child was referred to a neurosurgeon for evaluation of headache believed to be related to shunt disconnection or malfunction.