Disclosures: Evan M. Berlin, MD:

Case Description: This case describes chronic cough as the presenting symptom and chief complaint of patient with known normal pressure hydrocephalus status post ventriculoperitoneal shunt, with complete resolution of cough after adjustment of shunt setting.

Setting: Inpatient rehabilitation

Patient: 66-year-old male with pertinent past medical history of normal pressure hydrocephalus status post ventriculoperitoneal shunt who is admitted to inpatient rehabilitation with gait and ADL dysfunction after sustaining a right periventricular infarct. Patient participated well with therapy and progressed appropriately. The patient complained of a distressing daily cough, occurring for approximately 4-5 months, which did not resolve with the use of loratadine or fluticasone. His ace inhibitor was discontinued, and guaifenesin was started while inpatient, with minimal relief. Assessment/

Results: Vital signs remained stable during his stay, he was not tachypneic nor hypoxic on room air, and was afebrile. On physical exam the patient was clear to auscultation bilaterally. Radiographic imaging was normal, and respiratory viral panel was negative. Patient was unable to provide sputum sample for culture. The patient was seen in neurosurgery clinic who noted his Codman Certas valve was on a setting of 2-3 and was subsequently reprogrammed to the desired setting of 4.

Discussion: After reprogramming of his shunt, the patient had complete resolution of his cough within 48 hours. According to a systematic review of the literature, complication rate of shunts is around 38%, with shunt over drainage being the most common. However, cough is not a well-documented side effect.

Conclusion: There have been few case reports on chronic cough as the initial manifestation of hydrocephalus, but none to our knowledge of chronic cough as the primary symptom for shunt malfunction. This case aims to discuss the complications of ventriculoperitoneal shunts, and to spread awareness of chronic cough as a symptom of shunt malfunction in the setting of normal pressure hydrocephalus.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/chronic-cough-presenting-as-primary-symptom-of-ventriculoperitoneal-shunt-malfunction/