# Rare Complications of CSF Diversion: Paradoxical Neuroimaging Findings in a Double, Chiasmic Case Report

## TL;DR

This paper presents two cases where cerebrospinal fluid shunting led to confusing neuroimaging results, emphasizing the need to combine clinical history with imaging for accurate diagnosis.

## Contribution

The paper highlights the importance of integrating clinical context with neuroimaging to avoid misdiagnosis in cerebrospinal fluid shunting complications.

## Key findings

- Reduced ventricular size was misinterpreted as overdrainage but was actually due to increased intracranial pressure.
- Symptoms of intracranial hypertension were caused by overdrainage leading to tonsillar displacement and hydrocephalus.
- Adjusting shunt pressure resolved symptoms and imaging abnormalities in both cases.

## Abstract

Two patients with CSF shunting systems exhibited symptoms of altered intracranial pressure. Initial neuroimaging led to misinterpretation, but integrating clinical history and follow-up imaging revealed the true diagnosis. In the first case, reduced ventricular size was mistaken for CSF overdrainage, while the actual problem was increased intracranial pressure, as seen in slit ventricle syndrome. In the second case, symptoms attributed to intracranial hypertension were due to CSF overdrainage causing tonsillar displacement and hydrocephalus. Adjusting the spinoperitoneal shunt pressure resolved symptoms and imaging abnormalities. These cases highlight the necessity of correlating clinical presentation with a deep understanding of CSF dynamics in shunt assessments.