For patients with a VP shunt who present to the emergency department (ED), it is imperative to obtain a focused, yet detailed, history. In addition to the patient’s chief complaint, the questions in Table 2 should be asked of any patient with a VP shunt. Information regarding initial shunt placement and shunt revisions are key points to address, as the risk of blockage and infection is highest within the first few months following shunt insertion and revision.1 It is also important to ascertain whether anything has made the symptoms better or worse. In patients with mildly increased ICP, symptoms typically worsen when lying down and improve when upright. Conversely, in a patient with SVS, headaches typically worsen when upright and improve after lying down.53 It is also imperative to determine the type of shunt that was implanted. It is useful to be acquainted with the types of shunts used in the patient’s particular hospital/patient population.54 It is also necessary to obtain information regarding the patient’s recent level of activity, as changes in behavior or mental status can indicate a shunt complication. Parents often know best whether their child is acting normally or not.53
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