Serial neuropsychological assessment and evidence of shunt malfunction in spina bifida: A longitudinal case study

Myelomeningocele is often accompanied by hydrocephalus (MMH), making it a potentially unstable neurological condition requiting shunt placement and possible revisions. Serial neuropsychological assessment is an important toot in monitoring children with MMH, as cognitive changes can indicate shunt malfunction and. hydrocephalus. We present the case of a girl with MMH who had five neuropsychological assessments (ages 5, 7, 11, 12, and 14). Despite a lack of overt neurological symptoms or report of behavioral decline, testing at age 11 revealed decline in multiple neurobehavioral domains, and imaging at that time showed increased hydrocephalus, requiting shunt revision. Subsequent neuropsychological assessment conducted after a 2-year period of medical stability showed improvement and/or a return to baseline levels in some skill areas (i.e., working memory, verbal memory, visaomotor integration, and sustained attention), yet more lasting impairments in others (i.e., Verbal IQ, processing speed, organization, and response inhibition). These lasting cognitive deficits potentially impact independent completion of complex medical self-care tasks. This pattern of recovery highlights vulnerability of brain systems supporting executive functions in children with hydrocephalus and shunt failure.