A child with spina bifida presents with headache, vomiting, irritability, bulging fontanelles, new nystagmus, edema, redness, change in personality, and change in school performance. What are you concerned about?

• A. Meningitis
• B. Shunt malfunction
• C. Dehydration
• D. Migraine

Answer: (B)

A child with spina bifida who has a ventriculoperitoneal shunt now shows signs of increased intracranial pressure. Headache, vomiting, irritability, bulging fontanelles, and new eye findings like nystagmus all point to CSF not draining properly and the brain being under pressure. The changes in personality and school performance reflect cognitive and behavioral effects from raised ICP, which can happen quickly with shunt failure. The redness at the shunt site can occur with infection, but the overall pattern here – especially the ICP-specific signs – is most consistent with shunt malfunction leading to acute hydrocephalus, a medical emergency requiring urgent neurosurgical evaluation and imaging.

Meningitis would usually present with fever, neck stiffness, photophobia, and more systemic ill appearance; dehydration would show dry mucous membranes and a sunken fontanelle rather than bulging ones; migraines are not expected to cause new bulging fontanelles or new nystagmus in this context.