Escape from prism

Michael C Brodsky; Bryce J Aul; David J Daniels; Mays El-Dairi

doi:10.1016/j.survophthal.2022.02.003

Escape from prism

Surv Ophthalmol. 2023 May-Jun;68(3):556-561. doi: 10.1016/j.survophthal.2022.02.003. Epub 2022 Feb 15.

Authors

Michael C Brodsky¹, Bryce J Aul², David J Daniels³, Mays El-Dairi⁴

Affiliations

¹ Department of Departments of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA. Electronic address: brodsky.michael@mayo.edu.
² Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA.
³ Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
⁴ Department of Ophthalmology, Duke University, Durham, North Carolina.

PMID: 35181281
DOI: 10.1016/j.survophthal.2022.02.003

Abstract

A 14-year-old boy with a history of shunted congenital hydrocephalus began having headaches with nausea and vomiting after transcontinental flights. He gradually developed horizontal diplopia indicative of mild bilateral sixth nerve palsy, without papilledema or ventriculomegaly. Intracranial pressure monitoring showed no signs of elevation. After he subsequently developed papilledema, surgical exploration showed shunt malfunction, and shunt replacement produced rapid resolution of symptoms. This case demonstrates the importance of relying on clinical history and neuro-ophthalmologic examination in patients with hydrocephalus and suspected shunt failure, even when objective confirmatory evidence of intracranial pressure elevation is lacking.

Keywords: Hydrocephalus; intracranial pressure; papilledema; ventriculoperitoneal shunt failure.

Publication types

Case Reports
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Diplopia / diagnosis
Diplopia / etiology
Humans
Hydrocephalus* / complications
Hydrocephalus* / diagnosis
Hydrocephalus* / surgery
Intracranial Hypertension*
Male
Papilledema* / diagnosis
Ventriculoperitoneal Shunt