Ventriculoperitoneal Shunt-Associated Neuropsychiatric Symptoms: A Literature Review and Two Case Reports

Ventriculoperitoneal (VP) shunts are a common use for the treatment of hydrocephalus, which is a condition causing excessive cerebrospinal fluid (CSF) buildup in the brain. The shunt drains the CSF from the brain and into the abdomen, where it can be absorbed by the body. Although a widely used and successful procedure, it is unclear whether neurosurgical placement of this shunt may directly cause psychiatric abnormalities, especially regarding the dopaminergic system. In this paper, we first review relevant literature and discuss the dopamine circuitry in the brain. The literature suggests a shunt-associated clinical syndrome, which may include a reduction in facial and/or verbal expressivity, reduced willful movement, rigidity, and vertical gaze palsy. Typical presentation occurs within three months of a shunt revision. In patients with a VP shunt, these signs may be a strong indicator of mechanical or functional shunt malfunction. We then present two cases of hydrocephalus managed with a VP shunt, where both patients developed symptoms suggestive of psychosis and/or dopamine pathway pathology after shunt placement. We conclude that clinicians should have a suspicion for shunt-associated symptomology in patients with a history of recently treated hydrocephalus who present with psychomotor, personality, or cognitive changes.