Internal ventricular shunts are systems for draining excess cerebrospinal fluid to another body cavity in patients with hydrocephalus. They are subject to complications that are sometimes difficult to identify and can lead to diagnostic errors if practitioners are not enough aware. The most frequent complications are mechanical (drainage dysfunction) and infectious. Interruption of the drainage may causeneurological signs of intracranial hypertension; the diagnosis is usually easy. However, the clinical signs can sometimes be less obvious, and a dysfunction of the shunt should be evoked. A multidisciplinary management with the neurosurgery team is necessary to evaluate the appropriate investigation and the emergency management.