We discussed a scenario of 6 month old presenting with vomiting. there was evidence of a repaired meningomyelocele and insertion of VP shunt. We covered how to develop differential diagnosis in this case. And …
14 year old with universal cues of hemiplegic gait, shortening on left limbs but generally very well.

The learning points:

  • approach to a child with vomiting and ‘VP shunt’.
  • VP shunt examination for obstruction
  • CT Shunt series of head for quick assessment for ‘broken’ shunt
  • MRI is not appropriate as it takes long and will require sedation
  • Good brief description / summary of universal cues
  • Focused history questions
  • Specific examination: Neurological exam: Muscle bulk / Power / Tone / Reflexes – Augumentation
  • MSK examination: range of movements is more appropriate
  • Exam is a ‘Performance’ Write your own script for each station & PRACTICE, PRACTICE, PRACTICE

Add your comments or anything I may have missed.
Anil Garg