A 65-year-old man presented with headache, altered mental status, and somnolence. The patient had a ventriculoperitoneal (VP) shunt revised a month earlier. A CT of the head was performed, which demonstrated interval development of hydrocephalus compared with the prior examination done at the time of the shunt revision. Further evaluation of the VP shunt dynamics was obtained through a radionuclide shuntogram using 99mTcO4. The shuntogram demonstrated passage of the radiotracer down the VP shunt tubing. This case illustrates the utility of radionuclide shuntogram in demonstrating an unusual cause of hydrocephalus after VP shunt placement.
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