Shunt malfunction caused by mischievous twisting of the valve by the patient: case report

We report an instructive case of repetitive shunt obstruction caused by mischievous turning of the valve by the patient. A 7-year-old boy underwent shunt replacement for hydrocephalus caused by intraventricular hemorrhage at birth; the shunt had been revised a month earlier. The boy experienced occasional episodes of headache and vomiting after the revision. A shunt survey revealed a twisted tube just proximal to the valve. After the valve was returned to its original position, the symptoms resolved. The patient confessed to a recent habit of turning the valve. Although turning of the valve may be a potential cause of shunt obstruction, the use of craniography and/or a shunt series should be able to reveal these changes.