Ventriculoperitoneal Shunt-Associated Neuropsychiatric Symptoms: A Literature Review and Two Case Reports

Authors

  • Olivia R. Thomas Department of Neurosciences and Psychiatry, University of Toledo College of Medicine, Toledo, OH, U.S.A. https://orcid.org/0009-0002-3846-7549
  • Madhu Vishnu Sankar Reddy Rami Reddy Department of Neurosciences and Psychiatry, University of Toledo College of Medicine, Toledo, OH, U.S.A. https://orcid.org/0000-0002-8119-8447
  • Jacob F. Wood https://orcid.org/0009-0002-4480-3393
  • Jacob J. Tan Department of Neurosciences and Psychiatry, University of Toledo College of Medicine, Toledo, OH, U.S.A.
  • Tressel Holton Department of Neurosciences and Psychiatry, University of Toledo College of Medicine, Toledo, OH, U.S.A. https://orcid.org/0009-0005-2941-1641
  • Katherine Simer Department of Neurosciences and Psychiatry, University of Toledo College of Medicine, Toledo, OH, U.S.A. https://orcid.org/0009-0003-9287-9242
  • Samuel A. McCord Rutland Regional Medical Center, Psychiatric Services, Rutland, VT U.S.A. https://orcid.org/0009-0004-2191-4909
  • Daniel Maixner University of Michigan, Department of Psychiatry, Ann Arbor, MI, U.S.A. https://orcid.org/0000-0003-1460-8255
  • John Hammond Integrated Behavioral Health, Madison, AL, U.S.A. https://orcid.org/0009-0002-3389-4904
  • Robert E. McCullumsmith Department of Neurosciences and Psychiatry, University of Toledo College of Medicine, Toledo, OH, U.S.A., Neuroscience Institute, ProMedica, Toledo, OH, U.S.A.

DOI:

https://doi.org/10.46570/utjms-2026-1695

Keywords:

ventriculoperitoneal-shunt, hydrocephalus, Parkinson's Disease, catatonia, psychosis

Abstract

Ventriculoperitoneal (VP) shunts are a common use for the treatment of hydrocephalus, which is a condition causing excessive cerebrospinal fluid (CSF) buildup in the brain. The shunt drains the CSF from the brain and into the abdomen, where it can be absorbed by the body. Although a widely used and successful procedure, it is unclear whether neurosurgical placement of this shunt may directly cause psychiatric abnormalities, especially regarding the dopaminergic system.

In this paper, we first review relevant literature and discuss the dopamine circuitry in the brain. The literature suggests a shunt-associated clinical syndrome, which may include a reduction in facial and/or verbal expressivity, reduced willful movement, rigidity, and vertical gaze palsy. Typical presentation occurs within three months of a shunt revision. In patients with a VP shunt, these signs may be a strong indicator of mechanical or functional shunt malfunction.

We then present two cases of hydrocephalus managed with a VP shunt, where both patients developed symptoms suggestive of psychosis and/or dopamine pathway pathology after shunt placement. We conclude that clinicians should have a suspicion for shunt-associated symptomology in patients with a history of recently treated hydrocephalus who present with psychomotor, personality, or cognitive changes.

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Published

2026-02-17

How to Cite

1.
Thomas OR, Rami Reddy MVSR, Wood JF, Tan JJ, Holton T, Simer K, McCord SA, Maixner D, Hammond J, McCullumsmith RE. Ventriculoperitoneal Shunt-Associated Neuropsychiatric Symptoms: A Literature Review and Two Case Reports. Translation [Internet]. 2026 Feb. 17 [cited 2026 Feb. 17];15(S1). Available from: https://openjournals.utoledo.edu/index.php/translation/article/view/1695

Issue

Vol. 15 No. S1 (2026): Perspectives in Psychiatry: A Learners' Viewpoint

Section

Perspectives in Psychiatry: A Learner’s Viewpoint

License

Copyright (c) 2026 Olivia R. Thomas, Madhu Vishnu Sankar Reddy Rami Reddy, Jacob F. Wood, Jacob J. Tan, Tressel Holton, Katherine Simer, Samuel A. McCord, Daniel Maixner, John Hammond, Robert E. McCullumsmith (Author)

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