By Michael D. Lorenz DVM, Joe N. Kornegay DVM PhD
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Extra resources for Handbook of Veterinary Neurology 4th Edition
Parents need early encouragement to allow their child to mature and develop to his or her optimum potential. This encouragement can come from any member of the team but will start with the ward nurse, doctor, physiotherapist and play specialist, all of whom can help assess the individual child’s needs and use their expertise in guiding the parents. Each child is different and the levels of attainment of skills depend on many factors. In addition, the individual child’s overall development and adaptation to the world is greatly influenced by the attitude of his or her parents and the environment (May and Carter, 1995).
Stephen’s shunt did, in fact, block a few weeks following the first insertion, and again his recovery following the shunt revision was straightforward. At this time he was fitted with a multipurpose shunt – one that could be switched on and off. When he was two years old, Stephen fell and hit his head; he became unconscious rapidly. On returning again to the ward it was found that his shunt had been switched off by the blow to his head; he recovered quickly once it was turned back on again. Difficulties started when Stephen’s parents tried to place him in playschool.
Once all the equipment has been withdrawn, an external ventricular drain may be left in situ for a few days, to act as a safety valve should the fenestration prove not to be permanent. Cerebrospinal fluid drained through the fenestration is reabsorbed via the basal cisterns, back into the venous system. Postoperative care The child should be nursed in a head-up position once recovered from anaesthesia, to encourage CSF drainage through the fenestration. This drainage will initially be much slower than that achieved by a shunt and careful observation of the child is necessary including his or her neurological status.