A child with myelomeningocele at T7 presents with vomiting, lethargy, irritability, headache, and increased seizure frequency. The MOST likely cause is...

• A. Shunt dysfunction
• B. Latex allergy
• C. Tethered cord
• D. Chiari II malfunction

Answer: (A)

Elevated intracranial pressure from shunt dysfunction is the most likely culprit. In a child with myelomeningocele who often has a ventriculoperitoneal shunt for hydrocephalus, failure of the shunt means CSF isn’t draining properly. That buildup raises intracranial pressure, producing vomiting, irritability, lethargy, and headache, and it can trigger more frequent seizures. The other options don’t fit this cluster of symptoms: latex allergy usually causes dermatitis or systemic allergic reactions rather than signs of increased brain pressure; tethered cord tends to cause progressive neurological deficits in the legs and bladder issues rather than acute ICP symptoms; Chiari II malfunction can cause brainstem symptoms (like respiratory or swallowing problems) and sometimes hydrocephalus, but the specific acute signs here point most directly to shunt failure and rising ICP.