Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan.
Wayne State University School of Medicine, Carman and Ann Adams Department of Pediatrics, Division of Pediatric Neurology, Children's Hospital of Michigan, Detroit, Michigan.
Pediatr Neurol. 2018 Nov;88:59-64. doi: 10.1016/j.pediatrneurol.2018.08.005. Epub 2018 Aug 10.
Seizures are a common presenting symptom to the emergency department (ED) in children with intraventricular shunts (IVS). The incidence of shunt malfunction and the yield of imaging studies in children with IVS presenting with seizures is unknown.
We assessed the utility and diagnostic yield of evaluation for shunt malfunction in patients with IVS with seizure and identified clinical predictors for shunt malfunction in these children.
We performed a retrospective review of children aged zero to 21 years of age with IVS who presented to the ED with seizure between 2011 and 2015. Demographic, clinical, laboratory and radiological data were collected. Shunt malfunction was diagnosed based on whether a shunt revision was performed during the hospitalization.
We evaluated 408 ED visits (median age: six years [IQR: 3, 11], males 61.5%) for IVS with seizures. Few visits were for first seizure (37; 9.1%) or for status epilepticus (46 visits; 11.3%). Computerized tomography head was performed in 318 patients (95.2%), of which 32 scans (10.6%) were suggestive of shunt malfunction. A shunt series was performed in 302 (90.4%) and was suggestive of shunt malfunction in eight (2.6%) patients. Shunt malfunction was diagnosed in 40 of 408 visits (9.8%). Only a history of multiple (≥3) shunt revisions was significantly associated with shunt malfunction. There was no association between number, type, or prior history of seizures and shunt malfunction.
Our study demonstrates a low yield of imaging studies for the evaluation of shunt malfunction in children with IVS with seizures, and shunt malfunction is an uncommon cause of seizures in these children.
在脑室分流（IVS）患儿中，癫痫发作是急诊就诊的常见症状。IVS 患儿癫痫发作时分流器故障的发生率和影像学检查的阳性率尚不清楚。
我们评估了 IVS 伴癫痫发作患儿评估分流器故障的效用和诊断率，并确定了这些患儿分流器故障的临床预测因素。
我们对 2011 年至 2015 年期间因 IVS 癫痫发作而在急诊科就诊的 0 至 21 岁的儿童进行了回顾性研究。收集了人口统计学、临床、实验室和影像学数据。根据住院期间是否进行分流器修正来诊断分流器故障。
我们评估了 408 例因 IVS 伴癫痫发作的急诊科就诊（中位年龄：6 岁[IQR：3，11]，男性占 61.5%）。首次癫痫发作（37 例；9.1%）或癫痫持续状态（46 例；11.3%）的就诊次数较少。318 例患者行头颅 CT 检查（95.2%），其中 32 例（10.6%）提示分流器故障。302 例行分流器系列检查（90.4%），其中 8 例（2.6%）提示分流器故障。408 例就诊中有 40 例（9.8%）诊断为分流器故障。仅有多次（≥3 次）分流器修正史与分流器故障显著相关。癫痫发作的次数、类型或既往史与分流器故障均无相关性。
我们的研究表明，在 IVS 伴癫痫发作的儿童中，影像学检查评估分流器故障的阳性率较低，而分流器故障是这些儿童癫痫发作的罕见原因。
