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NEUROLOGY 1985;35:25
© 1985 American Academy of Neurology

Permanent visual loss after shunt malfunction

Hugo A. Arroyo, MD, James E. Jan, MD, FRCP(C), Andrew Q. McCormick, MD, FRCS(C) and Kevin Farrell, MB, ChB, DCH, MRCP(UK), FRCP(C)

Division of Child Neurology, Department of Paediatrics (Drs. Arroyo, Jan, and Farrell) and the Departments of Paediatrics and Ophthalmology (Dr. McCormick), University of British Columbia; and the Children's Hospital (Dr. Jan), Vancouver, BC, Canada.

Fourteen (1.8%) of more than 800 children evaluated in a Visually Impaired Program over 10 years became permanently blind during an episode of raised intracranial pressure secondary to shunt malfunction. Visual symptoms and papilledema were recognized in only three children at the onset of blindness. Clinical and radiologic findings suggested that the loss of sight was caused by a lesion in the pregeniculate pathway in nine patients, probably due to ischemia; five children in the postgeniculate group sustained infarcts of the occipital lobes. These cases highlight the importance of parent education and prompt treatment of raised intracranial pressure due to shunt malfunction.

Address correspondence and reprint requests to Dr. Jan, Visually Impaired Program, Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada.

Presented in part at the 35th annual meeting of the American Academy of Neurology, San Diego, CA, April 1983.

Accepted for publication April 17, 1984.




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