Slit Ventricle Syndrome: A Case Report

Purpose (a): Patients with increased intracranial pressure may have a VP shunt inserted for therapeutic relief of symptoms. Slit ventricle syndrome is a rare medical condition where brain compliance is decreased and there is a rapid increase in intracranial pressure. This condition may result in patients who have obstruction of drainage or CSF overdrainage of the ventricles. The patient may present with headache, nausea, vomiting, and focal neurologic defects. Early detection, diagnosis, and treatment are imperative to prevent further neurologic damage in the patient. An unusual presentation of Slit Ventricle Syndrome is examined and presented in a 42 year old female. Methods (b): A 42 year old Caucasian female with a past medical history of Bell’s palsy, Retinitis Pigmentosa, Pseudotumor cerebri s/p VP shunt with recent adjustments, pacemaker placement, chronic migraines, and recent CVA with residual left sided weakness presented to the Emergency Department for slurred speech, headache, left sided numbness, and confusion. Workup, patient limitations, and literature review is discussed. Results (c): The patient’s medical history and presence of medical devices limited the workup that the care team could perform. However, the care team was able to assess via CT the rapid drainage of the patient’s VP shunt as the source of CVA-like symptoms, and confirm the rare condition of Slit Ventricle Syndrome. The recent increase in VP drainage a month prior caused rapidly progressive intracranial hypertension, leading to stroke-like symptoms, memory impairment, increase in migraine incidence, and generalized headache. After resolution of neurologic deficits, patient was referred back to neurosurgery for adjustment of drainage settings. Conclusions (d): Slit ventricle syndrome should be considered in patients with intermittent intracranial hypertension and small ventricular size see on imaging. This condition is commonly seen in patients with a more progressive presentation over multiple months. The case presented demonstrates the importance of monitoring patients with VP shunts as well as the significance in assessing the source of migraines/headaches in complicated neurology patients.