Intraparenchymal pericatheter cyst in ventriculoperitoneal shunt failure

Description

A 60-year-old man status post right parieto-occipital ventriculoperitoneal shunt with programmable valve for indication of delayed hydrocephalus after aneurysmal subarachnoid haemorrhage returns to clinic 7 weeks after placement for insidious onset of headaches, confusion and gait imbalance. CT scan of the head without contrast revealed an intraparenchymal pericatheter cystic collection with severe oedema (figure 1). The patient denied systemic signs of illness, and laboratory markers for infection were low. A tap of the shunt reservoir revealed no spontaneous flow and difficulty in aspirating cerebrospinal fluid (CSF). Laboratory analysis of the fluid showed negative Gram stain, normal chemistry profile and cell counts. MRI of the brain showed a simple cyst with significant oedema, but no restricted diffusion or contrast enhancement of the cyst wall (figures 2 and 3). CT of the abdomen was benign, without evidence of pseudocyst or other cause of distal obstruction.

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