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Neurology (Expert Forum)
Psuedotumor cerebri pressure problems after shunt surgery
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Psuedotumor cerebri pressure problems after shunt surgery
by brainhurts, Jul 24, 2005 12:00AM
I have had two surgeries, one last year, another 3 weeks ago to place a lumbar shunt to drain spinal fluid that my body can't process normally. I have psuedotumor cerebri. Diamox does'nt work on me at all. The first shunt didn't work properly so they had to replace it. As soon as I came out of surgery I could tell it was working because my near blindness was restored and the pressure headaches were gone. But in their place was a very sharp and distinctly placed pain in the back of my neck, straight up the back of my head, around the crown of my skull, and around my eyes. If I move my head or eyes even slowly, I get a sharp pain in these areas, not an ache, a very sharp pain. The surgeon told me that my body was not use to the lower spinal fluid pressure and I would have to "pressurize". It has been 3 weeks, almost 4, and it is not better, sometimes it's worse. If I have to sneeze or cough, I have to make sure I'm hanging onto something, because the pain is so great I almost pass out. I'm worried that since the spinal fluid surrounds and protects the brain and eyes from bruising, am I doing damage to my brain? Will this condition go away? I am on medical leave at work because of this and I can not afford to be out much longer, but I can't imagine working in this condition. Pain meds don't work on me. The only way I can get the pain to subside is to lay on my side. But even this is not helping all the time now. The surgeon told me that the only other alternative I have is to take the shunt out and go blind!! I hope you can give me other suggestions. signed brainhurts
Doctor's Answer
by CCF-Neuro-M.D.-PW, Jul 29, 2005 12:00AM
Its not immediately clear what this new pain might be
It does seem temporally related to the shunt replacement though, so a cause related to this is suspicious
low pressure can also cause headache, which are usually worse on standing and better on lying, and with hydration and caffeine. The CSF pressure can be measured (either from the shunt or from a lumbar puncture) to see if the pressure is too low. Some shunts have a programmable valve (for example the MEDOS shunt) so the amount of shunting can be adjusted without another procedure
hopefully your surgeon is comfortable that the shunt is working properly. This can be evaluated by a shunt plain xray series and a CT or MRI scan of the head to confirm placement and ruleout hydrocephalus (expansion of the CSF spaces in a malfuncitoning shunt). You could also seek a second opinion. The Neurosurgery Department at the Cleveland Clinic could help you with this (Dr. Mark Luciano is our shunt expert)
Good luck
It does seem temporally related to the shunt replacement though, so a cause related to this is suspicious
low pressure can also cause headache, which are usually worse on standing and better on lying, and with hydration and caffeine. The CSF pressure can be measured (either from the shunt or from a lumbar puncture) to see if the pressure is too low. Some shunts have a programmable valve (for example the MEDOS shunt) so the amount of shunting can be adjusted without another procedure
hopefully your surgeon is comfortable that the shunt is working properly. This can be evaluated by a shunt plain xray series and a CT or MRI scan of the head to confirm placement and ruleout hydrocephalus (expansion of the CSF spaces in a malfuncitoning shunt). You could also seek a second opinion. The Neurosurgery Department at the Cleveland Clinic could help you with this (Dr. Mark Luciano is our shunt expert)
Good luck
You Dr.'s comment about the shunt or going blind unfortunately was a very poor comment. I have to believe that Dr.'s for somewhat frustrates about the lack of research and knowledge of this condition. The are no specific meds for it and no one seems to understand exactly what causes it.
I wish you the best.
I was diagnosed with PTC in Feb 05. I am a 27 year old female. I gained about 100 lbs in about a year. It started out with dizziness and blindness in my right eye, and debilitating headaches. I had already had a neurologist for history of migraines who sent me to an eye specialist. She did the visual field tests and the pictures of my optic nerves and immediately sent me to the ER for a spinal tap. It took 2 ER docs multiple attempts to finally get the tap which resulted in a high pressure (I don't know the exact number). I was hospitalized for a week or so for pain control (which is difficult since I have fibromyalgia). Following that I was told to lose weight and the PTC would resolve itself. In the meantime (2 months later) I needed another spinal