What do we do next?

[AndyS999]

Wife had a baby in Jan '10. She had a spinal epidural. After delivery she had severe headaches for days. After 5 days she was told she had a spinal leak and needed a blood patch. She had the patch done and felt relief. Over the next few months, headaches returned along with nausea, dizziness, etc. She went to the hospital in May. A CT scan revealed that she had hydrocephalus. An MRI confirmed this and she was sent to a neurosurgeon - Patel. The MRI showed that she had a blockage of CSF in the back of her head. Her cerebellar tonsils were herniated, but not to a great extent. It seems that she had acquired Chiari. Patel suggested an endoscopic third ventriculostomy, which she had done in June. That procedure provided relief, but never completely resolved the headaches. In Dec of '10 she had a CT scan done and was complaining of headaches (not as severe as the headaches prior to ETV, but still chronic and moderate). Patel suggested that the ETV worked, but not well enough. He told us she would need a shunt installed. Codman shunt was installed in 4/18/11 and set to 180. After 8 days of recuperation her headaches were worse than they were prior to the installation of the shunt. On 4/26/11 we returned to Charleston and had the shunt set to 200. We went home and her headaches eased a bit, but still did not resolve completely. We went back this past Friday, 5/6/11. Patel thought maybe we moved the shunt in the wrong direction and set it to 120. Within an hour my wife began having severe headaches. The shunt was then set back to 200. She was admitted into the hospital. An MRI of the lumbar spine was done to check for CSF leak. It did not show any signs of a leak. An MRI of her head was done last night. There were no signs of a leak, but the back part of her head still seemed a bit crowded. Today we tried moving the shunt down to 160 and her headaches are worse. Dr. suggest clamping the shunt closed. Says Chiari decompression may be needed. We need more opinions.

[AndyS999]

Here is a link to the doctor's credentials. He is professor and co-chair of Neurosciences at MUSC. You can read more details here: http://neurosciences.musc.edu/faculty/full_time/patel.html

My wife just had surgery to clamp the shunt. She is in post-op now and doing well. I do not have her x-ray available, but will soon have a copy of that, her MRI's, CT Scans, etc. I would be more than happy to send all of those to you to get your opinion.

It is weird. WIthout the shunt she still has hydrocephalus. With it, she has low pressure headaches even set at 200. What do you think is going on? No leak shows up on MRI.

[Dr_Nassim]

Please first be sure that the surgeon is skilled in what he did (because you mentioned some terrible words concerning the qualification of your neurosurgeon)


You can sedate her for 48 h
set the valve to 105 mmHg
Do not panic if she has headach (be sure that she is psychologically stable)

Finally do your best to send me her lateral view skull x-ray