SAQ 939 – Neurosurgery – VP shunt hydrocephalus and refractory seizures

An 18-year-old man is brought to a small rural ED by his parents. He had a VP shunt inserted for hydrocephalus at age 10, with the last revision three years ago.

He has had increasing headache and vomiting for two days and is now confused.

Observation	Value
Temperature	37.3 degrees C axillary
Pulse	114/min regular
BP	140/70 mmHg
GCS	14

List five potential causes for this presentation.

(Marked out of 5.0)

/ 5

List initial laboratory investigations and give the rationale for each.

(Marked out of 10.0)
</p> <table class="saq-prop-table" style="width: 100%; max-width: 100%; table-layout: fixed; border-collapse: collapse;"> <thead> <tr> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Investigation</th> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Rationale</th> </tr> </thead> <tbody> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Investigation 1</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Investigation 2</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Investigation 3</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Investigation 4</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Investigation 5</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> </tbody> </table> <p>

/ 10

A CT brain shows marked hydrocephalus. The patient becomes drowsy and has a tonic-clonic seizure. Outline five initial treatment steps.

(Marked out of 5.0)

/ 5

Despite treatment, seizures persist for 30 minutes. What five further steps would you take?

(Marked out of 5.0)

/ 5

Total Score: 0 / 25

Percentage: 0%