PostOperativeCare

[Kyran__0]

  My father-in-law had developed deteriorating gait, dementia, and
  incontinence over a period of three years, before he was finally
  diagnosed with NPH.
   He had a CT done and the gerontologist referred him to a
  neurosurgeon who then  decided to implant a shunt. After the surgery he
  miraculously  recovered. He began to walk very well, the incontinence and
  the dementia disappeared.
   However, since the operation he seems to have
  undergone a personality change. He now constantly complains about
  headaches, nausea and loss of appetite.
    We were wondering if this isnormal after such an operation and whether the situation will improve withtime or whether the shunt is over draining or if there could be some other unidentified problem causing these symptoms. Is there anything that can relieve the headache and nausea? Any information will be greatly appreciated. Thank you.
  Kyran

[CCF Neuro[P] MD RPS]

_
Dear Kyran:
Sorry to hear about your father.  Most of the time, a shunt will have no problems.  However, there is always a concern about two things: shunt malfunction and infection.  It doesn't sound lke the latter as there is no fever, stiff neck, etc.  But, a shunt malfunction is always a possibility, especially after a dramatic change for the better than a slow reversal.  I would go back to the neurologist and have him checked out.  A good neurological exam and CT will give you the diagnosis of too much or too little draining (shunt malfunction).  Most shunts have different settings and if there is too much drainage then a quick resetting of the pressure of drainage will be the cure.  Another possibility is that with the shunting, the relatively quick change in CSF pressure downward might cause some rupture of the meningeal veins and small subdural bleeds might happen.  The CT will rule this out.
So, go to the neurologist and have your father examined and head imaged.  I hope that it is a simple problem.
Sincerely,
CCF Neuro[P] MD