Bradycardia without hypertension; is it a common clinical presentation of ventriculoperitoneal shunt malfunction in pediatric patients?

Itay Marmor, Gary Carbell, Jake Koplowitz, Jonathan Roth, Nir Shimoni, Shlomo Constantini, Ayelet Rimon, Miguel Marcelo Glatstein*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Mechanical shunting of cerebrospinal fluid is an effective treatment for hydrocephalus. Some studies suggest that bradycardia without hypertension may also be observed in ventriculoperitoneal (VP) shunt malfunction; however, in our experience, this is not a common presenting sign. Objective: The aim of this studywas to evaluatewhether bradycardiawithout hypertension was a common sign in patients presenting to the pediatric emergency department (ED) with a VP shunt malfunction. Methods: A retrospective observational study, from May 2006 to April 2015, which included a randomsample of children admitted to the EDwith clinical features suggestive of possible VP shunt malfunction. Control patientswere defined as thosewho arrived at our EDwith suspected VP shunt malfunction that was later ruled out on further workup. Results: A total of 65 patients were included in this study. A significantly greater number of patients with a confirmed shunt pathology presented with vomiting (P = 0.01) and lethargy/apathy (P = 0.01). In the control group, a significantly greater number of patients presented with fever (P = 0.004) and seizures (P = 0.02). The number of patients presenting with bradycardia was not significantly different between the shunt pathology and control groups (P > 0.05). Conclusions: Bradycardia is not a common presentation in patients with VP shunt malfunction. Bradycardia is often recognized as a significant sign; however, it is one of the last presenting signs. Educating patients about the early signsmust be considered as part of the treatment forVP shuntmalfunction.

Original languageEnglish
Pages (from-to)E817-E820
JournalPediatric Emergency Care
Issue number12
StatePublished - 1 Dec 2021


  • Bradycardia
  • Malfunction
  • Ventriculoperitoneal shunt


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