Slit-ventricle syndrome masking shunt disconnection in adulthood

A male in his 20s was referred to the neurosurgical service with headaches, vomiting and personality changes. He had a previous history of bilateral ventriculoperitoneal (VP) shunts and bitemporal decompressive surgery for neonatal intraventricular haemorrhage. There were appearances of slit-ventricles on his CT head scan typically associated with adequate cerebrospinal fluid drainage and normal intracranial pressure (ICP), which ordinarily will have limited further investigation. However, an X-ray shunt series demonstrated a right shunt disconnection at the neck and ICP monitoring confirmed raised ICP with poor brain compliance. He underwent revision of the right VP shunt with distal catheter replacement. Postoperatively, his symptoms, ICP and brain compliance improved.This case highlights the value of obtaining shunt series in patients presenting with symptoms of shunt obstruction regardless of a normal CT head. It emphasises awareness of slit-ventricle syndrome in adult patients with shunts, particularly those with complex childhood hydrocephalus.