طفل عمره ٤ سنوات عنده صمام تصريف دماغي بطني (VP shunt) منذ الولادة. جاء بصداع وقيء صباحي منذ يومين، ونعاس متزايد، ولم يعد يلعب. لا توجد حرارة، والنبض ٧٢، والضغط ١١٨/٧٠. ما الأرجح؟

A 4-year-old with a VP shunt since birth has had headache and morning vomiting for two days, increasing drowsiness and has stopped playing. He is afebrile; HR 72, BP 118/70. What is most likely?

1. Simple viral gastroenteritis
2. Childhood migraine
3. Shunt malfunction with raised ICP
4. Late teething causing vomiting and sleepiness

Answer: C) Shunt malfunction with raised ICP. Headache, vomiting and drowsiness in a child with a shunt mean malfunction until proven otherwise and need urgent assessment. Fever with abdominal pain may indicate shunt infection.