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At 16:25 17/08/98 -0500, jay pershad wrote:
>I was wondering if folks could share their experience or any references on
>the likelihood of VPS malfunction in the clinical setting of an isolated
>seizure (first time or recurrent, febrile or afebrile) ?
 
In our experience, a seizure may occasionaly be one of the presenting
symptoms of a shunt dysfunction, but scarcely ever is the only one. Nearly
always other more common symptoms as headache, vomiting or decreased
consciousness will be present. In the case of an isolated first seizure I
would investigate the posibility of an epilepsy; if recurrent this
possibility is still higher and I would order anticonvulsant levels, if it
is appropriate; if febrile but the patient has been shunted more than three
months ago the possibility of a shunt infection and malfunction is low and
a febrile seizure would be my first diagnosis.
 
I have not own data but in a review of Johnson (Pediatr Neurosurg 1996; 24:
223-7)only 16 of 1,831 shunt revisions (0.9%) were associated with a=
 seizure!
 
 
 
Dr. Juan Jos=E9 Garcia Garcia
Pediatric Emergency Department
Hospital Sant Joan de D=E9u
Barcelona, Spain
 
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