PURPOSE: To treat a 30-year-old man with a ventriculoperitoneal shunt who had progressive visual loss. METHODS: The patient underwent computed tomographic and magnetic resonance imaging scans and ocular examination. RESULTS: He was diagnosed with ventriculoperitoneal shunt failure despite the lack of ventriculomegaly on computed tomographic scan of the head and the lack of papilledema. The patient eventually underwent ventriculoperitoneal shunt revision, but visual function did not improve. CONCLUSIONS: Loss of visual acuity or visual field, or both, may be the initial and only symptom of ventriculoperitoneal shunt malfunction. Shunt failure may occur without other features of increased intracranial pressure or ventriculomegaly on neuroimaging studies.
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