A recent study suggests that using ocular ultrasound in the emergency room can help quickly and safely detect children with failed brain drains.
The study was presented at the Pediatric Academic Society (PAS) 2024 meeting in Toronto.
A ventricular shunt is a small plastic tube surgically placed to drain excess fluid and relieve pressure on the brain. Ventricular shunts are used in children to treat hydrocephalus, a condition caused by improper drainage of fluid from the brain or resorption by tumors, bleeding in the brain, and other sources. According to experts, approximately 30% of shunts will rupture, become misaligned, or become clogged within two years of implantation, and an additional 5% will fail each year thereafter.
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When patients go to the emergency room with potential shunt failure, their symptoms are often nonspecific and include headache, vomiting and fatigue, the researchers said. Shunt failure can be life-threatening, and children with shunts often undergo multiple computed tomography and magnetic resonance imaging scans each year, exposing them to excessive radiation and sedation. The fluid buildup causes swelling of the optic nerve sheath, which researchers can measure using ocular ultrasound.
Studies have found that comparing the diameter of a patient’s optic nerve when they are symptomatic to when they are healthy can help determine whether the shunt is blocked.
“The research team was interested in finding ways to reduce radiation exposure and speed up the diagnosis of failed triage in the emergency department,” said Adrienne L. Davis, MD, MS, FRCPC, director of pediatric emergency medicine research at The Hospital for Sick Children (SickKids), introducing the authors. “This study used patients as their own controls by measuring the optic nerve in health and disease—a strategy that individualizes the testing for each patient and recognizes that each patient undergoing shunting has a unique degree of Shunt dependence and ability to tolerate high brain stress.”
The researchers performed ultrasound examinations of 76 pairs of eyes of nearly 60 children presenting to Toronto hospital emergency departments with possible shunt failure. The researchers note that while the findings are encouraging, the results need to be further confirmed in a larger population of children undergoing diversion in North America.