Cerebral Concussion, Basal Skull Fracture vs. Shunt Dysfunction
Left picture: The diagnosis is a basal skull fracture with cerebral concussion (a longitudinal pyramidal fracture on the CT), where post-auricular or subconjunctival ecchymosis may be an indication of a basal skull fracture. Right picture: The diagnosis is an acute shunt insufficiency. Palpable and visible abnormal findings of the valve and the shunt system are only significant in combination with clinical signs of shunt insufficiency like in the demonstrated case. It is to be noted that a persistent dent of the valve chamber after pumping is a more telling sign than increased resistance of the valve chamber on pumping.
In both patients a swelling is palpable behind the right ear. Both children had or have a clouding of consciousness, cephalea and vomiting. Left picture: Here, a head injury has occurred. Right picture: No history of trauma to the head can be discovered. Left picture: On looking closely, a retromastoidal hematoma is recognizable on the right side. Right picture: Here, a valve of a ventriculoperitoneal shunt is visible and palpable behind the right auricle with a permanent dent over the valve chamber.