neck pain shunt problems after MRI

[bobswife5150]

Hi,

My husband became paralyzed after a spinal operation in June 2011. He had problems with spinal fluid leaking so he had a brain shunt inserted on the left side of his head in Aug. 2011. He's been in therapy for months & was going home on Tuesday Oct 4.  On Thursday Sept. 29 his therapy doctor ordered an MRI of his back "just to make sure everything is ok."  After the MRI my husband immediately had a headache & stiff neck, shoulders & arms.  We think the MRI messed up the brain shunt.

The next morning, only the neck pain remained. The neck pain is positional, that is, it does not hurt when he is reclining in his wheelchair or lying in bed, but sitting upright in his wheelchair is very painful.  Warm compresses  help, but the neck pain does not go away.

The Drs and therapists tell us there are knots or trigger points in his neck & massage them, but it does not help. His Dr. stuck needles in the knots and added numbing medicine to them, but it did not help.

The doctors tell us that the shunt is fine and is working correctly.  My husband did not go home on Oct 4.  Nothing is improved after 9 days--the doctors are stumped.  He is getting headaches behind his right eye.

On October 7, he had an MRI done of his neck and head.  Nothing showed up unusual.
The shunt is readjusted back to what it was--.5.  He can sit upright without pain. We are thrilled.

Today, October 8, in the morning the neck pain returned, with him unable to sit upright without pain again. His neurosurgeon came and changed the shunt setting to 1.  It did not help.  He will return tomorrow to change it back to .5.

Everyone is stumped that he was fine before the first MRI and had instant neck pain right after the first MRI and that the pain is positional--happening only when sitting upright.  It seems that something is wrong with the shunt, but the MRI showed no problems with it. He cannot go home until his neck pain is gone. Please help, thank you.

[Sudhir Kumar, MD]

Dear bobswife5150,

I appreciate the details that you have provided about your husband's problem.

I will try my best to provide my opinion based on the available information, which I feel you have provided very well. But as you would understand, without examining the patient and reviewing the reports, it is difficult to provide a definite opinion.

Shunt surgery is a procedure undertaken when there is increased intracranial pressure. It can be thought of as a method of diverting the brain fluid from the brain to the peritoneal cavity (abdomen).

In your husband's case everything seems to be as before except for his neck pain, for which there does not seem to be any obvious cause. However, after going through the description of the pain, I think it is a "low pressure" headache.

In this condition, a person has severe headache and neck pain located at the back of the lower part of head (occipital region) and neck. Pain is maximum when in upright posture (sitting or standing) and subsides when reclining (sleeping posture). Patient may have accompanying symptoms such as nausea, vomiting or giddiness. The cause of pain in this condition is low CSF pressure. As I mentioned earlier, shunt surgery is done in cases of elevated intracranial (CSF) pressure to lower the CSF pressure, but in some cases the pressure may become too low, resulting in headache and neck pain.

Neurosurgeons approach this problem in several ways. They may try to adjust the parameters in the shunt. Some surgeons prefer to insert a variable pressure shunt. In these shunts, shunt pressure can be adjusted as desired in an OP setting. In rare cases, the shunt may even have to be removed.

Other causes of neck pain could also be intermittent shunt obstruction. Cervical spondylosis is another important cause of neck pain, but I believe it has been excluded by a neck MRI.

I suggest you discuss these issues with your neurosurgeon. I am sure your problem will soon get solved. I have seen some similar cases in my practice and they have all recovered well.

Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards,
Dr. Sudhir Kumar

[jennabeautiful]

Every time your husband goes in for an MRI he should have the shunt reprogramed. That os what I have to do after every MRI that I receive also because of my shunt