The clinical presentation of a ventriculoperitoneal shunt (VP-shunt) dysfunction depends on whether the cranial sutures are still unfused, and on the cause and severity of the VP-shunt obstruction. A suspicion of a VP-shunt dysfunction is always reason to consult with a neurosurgeon. A patient with a suspected VP-shunt dysfunction that presents with elevated intracranial pressure should be urgently assessed at the emergency department of a neurosurgical center. Conclusions about whether the ventricular system is enlarged should be based on comparison between the imaging made to demonstrate the VP-shunt dysfunction and a reference scan of the brain, made when the patient was in a good clinical condition. In a patient with small ventricles, but clinical indications of elevated intracranial pressure, a VP-shunt dysfunction can't be ruled out. In that case fundoscopy may be very valuable to rule out papilledema.