Cephalad Intracranial Migration of a Lumboperitoneal Shunt Catheter in a Patient with Idiopathic Intracranial Hypertension: A Case Report
TL;DR
Cephalad migration of an LP shunt catheter is a rare but important cause of apparent treatment-refractory IIH that can mimic ordinary shunt malfunction and should be considered whenever a patient with an LP shunt has unexplained persistence of raised intracranial pressure.
Abstract
Background
Lumboperitoneal (LP) shunting is an established treatment for medically refractory idiopathic intracranial hypertension (IIH), but is limited by comparatively high rates of mechanical failure. Cephalad (proximal, cranial) migration of the shunt catheter is a rare and likely underrecognized cause of shunt failure, with only a small number of cases reported. Case presentation: We report a 38-year-old woman with a three-year history of chronic headache, nausea, and blurred vision due to IIH, who remained symptomatic despite acetazolamide, serial therapeutic lumbar punctures, and two sequential LP shunt procedures. Repeat lumbar puncture opening pressure remained markedly elevated (450 mmH₂O) after the second shunt. Cross-sectional imaging of the skull, spine, and brain, including three-dimensional reconstructions, demonstrated cephalad migration of the shunt catheter from its intended lumbar-to-peritoneal course, with the tube ascending along the spinal canal and neck and its tip lying within the cranial cavity, in proximity to the ventricular system. On examination the patient remained neurologically intact but had persistent bilateral papilledema with peripheral visual-field constriction.
Conclusion
Cephalad migration of an LP shunt catheter is a rare but important cause of apparent treatment-refractory IIH that can mimic ordinary shunt malfunction. It should be considered whenever a patient with an LP shunt has unexplained persistence of raised intracranial pressure, and confirmed with dedicated imaging of the full catheter course from the lumbar spine to the abdomen.