Which signs might indicate VP shunt malfunction in a child or adult?

• A. Headache and vomiting
• B. Lethargy or irritability; bulging fontanelles in infants.
• C. Fever only.
• D. Headache, vomiting, lethargy or irritability; in infants bulging fontanelles; fever may indicate infection.

Answer: (D)

Problems with a ventriculoperitoneal shunt typically lead to increased intracranial pressure because CSF drainage is blocked or the shunt malfunctions, so the signs you look for are those that reflect pressure changes in the brain. Headache and vomiting are classic ICP symptoms in adults and older children. In infants, they can’t verbalize pain, so irritability or lethargy becomes a key sign, and the fontanelles can bulge because the skull bones haven’t fused yet, allowing pressure to push outward. Fever is also important to consider because infection can accompany shunt problems and worsen outcomes; while fever alone isn’t proof of malfunction, its presence with these neurological or developmental changes heightens concern for shunt infection and requires urgent evaluation. Together, these signs point to a possible VP shunt issue and prompt rapid assessment by a neurosurgeon with imaging to determine patency and need for revision or infection treatment.