A ventriculoperitoneal shunt induced chorea: A case report and review of the literature of movement disorders associated with shunt

Abstract Background: Hemi-chorea following placement of a ventriculoperitoneal shunt in a patient with hydrocephalus is rare. This complication is often misdiagnosed, which delays treatment. Here we present a rare case of hemichorea following placement of a ventriculoperitoneal shunt and the literature on movement disorders associated with the CSF shunt. Case presentation: A 1.5-year-old male child B/B parents with chief complaints of multiple episodes of emesis and lethargy. Non-contrast CT is suggestive of hydrocephalus. The patient underwent a cerebrospinal fluid diversion procedure; a ventriculoperitoneal shunt was placed through a right occipital approach. After the procedure, he developed brief, abrupt, irregular, unpredictable, non-stereotyped choreo-athetotic movements of the left upper and lower limbs. These movements cause problems with feeding. Post operative-MRI scan of the brain showed the tip of the shunt abutted the medial aspect of the thalamus and caudate nucleus and diffuse foci of micro infracts involving the left caudate and putamen, as well as the right internal capsule and putamen, and the brain stem. Symptoms showed a good response to tablet aspirin. Conclusion: We report that hemichorea is an uncommon complication of ventriculo-peritonieal shunt. placement. Neurosurgeons should know the early warning signs for focal deficits, including unilateral movement disorders, in patients with CSF diversion procedures, and postoperative MRIs also help in diagnosing the cause of movement disorders.