Aa
Which way to go now?
Hi. I am in need of some help please. I was diagnosed in July last year with IIH.Opening pressure was 46.After trying lumber punctures and Diomax with no possitive result it was decided I should have a VP shunt fitted,Nov 25th 08. After 10 days with no headache or eye pain all the symtoms have returned. The papillodema have only slightly improved. After waking in the morning, it takes between a half hour and two hours for the symptoms to start. Nausea, dizzeness,tinnitus,blurry vision and headache. I have had x-rays and Cat scan to confirm that the shunt is working. My neuro surgeon is now suggesting a LP shunt. We are doing a lp first but Im wondering if I need such a drastic next step?I am, at this point, afraid to go ahead with another surgery.Can any one help me and advise as what I could do next? Also I have lost 22lbs and am no longer over weight.Thank you very much.Cath278.
MEDICAL PROFESSIONAL
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is nor can I recommend the next step for you. However I will try to provide you with some useful information.
In patients with IIH who are treated with VP shunts, there are 3 possible causes for the headaches. The first is that the shunt is under-draining: that there is still too much fluid/pressure. This would best be assessed with a shunt tap or a lumbar puncture that measures the fluid pressure, or adjustment of the shunt to allow it to drain more, to see if the headaches improve. Another possible cause is that the shunt is over-draining, leading to too low of a pressure that can also lead to headaches. The headaches related to over-draining classically improve when the person lies down and gets worse when the person sits or stands. The third possible cause is that in addition to IIH, you have an additional headache disorder such as a migraine disorder. With migraines being so common, it would not be surprising that you happened to have 2 problems that lead to headache. However, this diagnosis is only made when the other two causes are excluded.
It is very important to follow-up with your eye doctor to ensure your visual fields are not being impaired due to the papilledema, because chronic pressure on the optic nerves can lead to permanent vision loss.
An MRV, which is like an MRI but for the veins of the head, is sometimes indicated in patients with IIH to ensure the cause is not narrowing of the veins in the head.
Again, I can not comment on whether or not there is a problem with your shunt without being able to examine you. However, I strongly recommend continued follow-up with your neurosurgeon and eye doctor. If you have not been evaluated by a headache specialist, and shunt problems/increased pressure problems are excluded, this may be beneficial to you as well.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is nor can I recommend the next step for you. However I will try to provide you with some useful information.
In patients with IIH who are treated with VP shunts, there are 3 possible causes for the headaches. The first is that the shunt is under-draining: that there is still too much fluid/pressure. This would best be assessed with a shunt tap or a lumbar puncture that measures the fluid pressure, or adjustment of the shunt to allow it to drain more, to see if the headaches improve. Another possible cause is that the shunt is over-draining, leading to too low of a pressure that can also lead to headaches. The headaches related to over-draining classically improve when the person lies down and gets worse when the person sits or stands. The third possible cause is that in addition to IIH, you have an additional headache disorder such as a migraine disorder. With migraines being so common, it would not be surprising that you happened to have 2 problems that lead to headache. However, this diagnosis is only made when the other two causes are excluded.
It is very important to follow-up with your eye doctor to ensure your visual fields are not being impaired due to the papilledema, because chronic pressure on the optic nerves can lead to permanent vision loss.
An MRV, which is like an MRI but for the veins of the head, is sometimes indicated in patients with IIH to ensure the cause is not narrowing of the veins in the head.
Again, I can not comment on whether or not there is a problem with your shunt without being able to examine you. However, I strongly recommend continued follow-up with your neurosurgeon and eye doctor. If you have not been evaluated by a headache specialist, and shunt problems/increased pressure problems are excluded, this may be beneficial to you as well.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
To Dr. Chahine,
Thank you very much for taking the time to answer my question. You have also provided me with some tests that can be done before we jump right back into surgery.I have been trying to work with my neuro-surgeon by finding out as much as I can myself. I am reluctant to have more surgery with out first exploring all other possibilities.Again, thank you! Cath278.
Thank you very much for taking the time to answer my question. You have also provided me with some tests that can be done before we jump right back into surgery.I have been trying to work with my neuro-surgeon by finding out as much as I can myself. I am reluctant to have more surgery with out first exploring all other possibilities.Again, thank you! Cath278.
You are reading content posted in the Neurology Forum
Find out how beta-blocker eye drops show promising results for acute migraine relief.
In this special Missouri Medicine report, doctors examine advances in diagnosis and treatment of this devastating and costly neurodegenerative disease.
Here are 12 simple – and fun! – ways to boost your brainpower.
Discover some of the causes of dizziness and how to treat it.
Discover the common causes of headaches and how to treat headache pain.
Two of the largest studies on Alzheimer’s have yielded new clues about the disease
