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Old 05-25-2005, 08:30 PM
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Default Malfunctioning Shunt

SUBJECT MATTER or KEY WORDS: <BR><BR>Communicating Hydrocephalus<BR>High CSF Levels in the Cranium<BR>Raised Intracranial Pressure<BR>Lumbar Punctures<BR>Sixth Nerve Palsy <BR>Subarachnoid Cysts<BR>Shunts<BR>Neurology<BR>Neurosurgery <BR><BR><BR>I am a retired electrician but I have experienced something over the last few months that may be helpful to a lot of doctors and patients.<BR><BR>I am writing this letter and putting it on the Internet to help doctors, patients and the parents of patients understand a particular neurological condition that as far as I know, has never before been described or evaluated. If this new information can help one patient it will be worth the time and effort it takes to write this letter.<BR><BR>In the beginning of November 2004, my 22 year-old son experienced a terrible headache. At that time he was enrolled in his final class for a degree in Computer Engineering at a large prestigious university. He reported to the emergency room of a well-respected hospital, where they gave him pain medication progressing up to IV Demerol and then morphine. <BR><BR>The pain continued, and when his intracranial pressure went too high he experienced “Sixth Nerve Palsy” in both eyes. Finally he was given a spinal tap or lumbar puncture (after he was hammered by Sixth Nerve Palsy) and it was discovered that his cranial pressure was over 400 mm rather than the normal 130 mm.<BR><BR>When my son was 7 years old it was discovered that he had a large subarachnoid cyst. It was decided that this cyst should be drained and he underwent neurosurgery. A shunt tube was inserted into his cyst and a valve was placed under the skin behind his right ear, and his shunt tube vented in his peritoneum. This was later modified with a new valve and tube when he was 9. After his first and second surgery my son would occasionally experience a migraine like headache; but during the three years prior to November of 2004, he never had a headache. <BR><BR>When he reported to the emergency room in November, the first thing the medical staff suspected was that my son’s shunt tube might be plugged-up. But his cyst had long been drained and an MRI and CAT Scan showed that it had not re-inflated. Because of this fact my son’s Neurologist and Neurosurgeon believed that a blocked shunt tube was impossible. <BR><BR>Often, raised intracranial pressure (ICP) is caused by too much cerebrospinal fluid or CSF in the skull. This occurs when CSF is not being properly vented from the skull; it is not caused by the overproduction of CSF. Only in very rare cases does the body produce too much CSF. Yet, my son was given increasing amounts of Diamox to suppress the production of his CSF, starting with 500 milligrams twice a day and later increased to 1250 mgs twice a day. The only effect of this Diamox was to make him very nauseous and very weak; and his CSF pressure stayed sky high.<BR><BR>During his spinal taps CSF was withdrawn, and his pressure would be manually reduced from over 400 mm to 120 mm. This would give him relief for about two days, on the third day a headache would start, by the fourth day he was in real pain, and by the fifth day either my wife or I would have to take him to the emergency room for another spinal tap. (He had a total of five spinal taps during his six-week ordeal.) He was always very weak, his eyes were in trouble and he often needed a wheelchair. <BR><BR>As a last desperate measure it was decided by our neurosurgeon to install a second shunt tube in my son’s right ventricle. He intended to tie this new shunt tube into the old shunt tube just below my son’s neck. <BR><BR>The operation took place on December 13, 2004. When the neurosurgeon cut into the old shunt tube to make his splice, he discovered that the CSF in the tube was under great pressure (because liquid shot all over). After further analysis he discovered that the old shunt tube was plugged in the peritoneum. A new tube was inserted into the peritoneum and my son’s six-week problem/agony/nightmare was over. (Except for his Sixth Nerve Palsy, which hopefully will correct itself over the next nine months.) For about two weeks after his surgery, my son had a very mild and very brief headache most mornings (which he treated with Viconin). These headaches have now completely stopped and he is regaining his strength. <BR><BR>During the six-week ordeal prior to his surgery, my son was in and <BR>out of the hospital three times. He was discharged twice because he felt a lot of relief after a spinal tap. <BR><BR>At the end of this letter I am going to retype the final paragraph from my son’s December 13th “Surgical Report”. This paragraph further explains my son’s medical situation. Part of this report describes how and why my son has “communicating hydrocephalus”. Apparently he was born with this condition. This condition was not previously discovered because a portion of his CSF was draining into this cyst until he was 7 years old. Then it was draining or “percolating” into his cyst and from there down through his shunt to his peritoneum or abdomen.<BR><BR>Six weeks after his shunt was plugged his condition was properly diagnosed during surgery. As the reader of this letter will see from the surgical report, a new, and medically unreported condition presented itself. It is assumed in the medical literature that a cyst acts like a balloon, and CSF does not penetrate the membrane of this balloon. In other words, communicating hydrocephalus cannot vent into a cyst. My son’s case proves that this is not true. CSF can “somehow percolate” into a cyst. Therefore, it is vital for a physician to quickly determine if a shunt is active, and if it is working properly. Apparently this is not an easy task. <BR><BR>Before retyping the last paragraph of the surgical report I would like to say something to the parents of children with hydrocephalus. It is sometimes believed that children born with this affliction suffer brain damage and/or mental retardation; and in some cases this may be true. However, my son has an IQ of 150, and he had a “composite” score in the 99th percentile on his ACT test for college. He is also well-spoken and has always done very well in school. I only state these facts because of comments I have heard about hydrocephalus and mental retardation.<BR><BR>Also, despite the tone of parts of this letter, my son’s Neurosurgeon saved his life and kept him from incurring permanent brain damage; and for that, I will be forever grateful. <BR><BR><BR>Surgical Report<BR><BR>“Postoperative Diagnosis: Communicating hydrocephalus with obstructed distal peritoneal catheter in the right cystoperitoneal shunt system.”<BR><BR>Last Paragraph of the Neurosurgeon’s Report:<BR><BR>“Again it is now clear that this patient’s symptoms were due to the obstruction of the distal peritoneal catheter in the abdomen. It is also clear that the patient had an existing communicating hydrocephalus that the CSF was somehow percolating into the right sylvian fissure and into the arachnoid cyst, which had collapsed. The proximal catheter and the valve system were in fact working. It should also be noted that this patient’s ventricular system was really not enlarged compared to scans taken as far back as 1993. In the MRI scan it only showed minor percolation of CSF across the ventricular wall in the right frontal area. The rest of the ventricular system did not show any evidence of transependymal flow. If this in fact is correct it explains perfectly what the patient’s symptoms were and why he did better with lumbar puncture and so on. I have told the parents prior to this dictation these statements and wrote it out for them so that any time there is a problem in the future if the patient is not in this area that this concept is understood so that future neurosurgeons can look toward this shunt system as the treatment for his communicating hydrocephalus.”<BR><BR>[If anyone reading the above letter wishes to talk to the author of this letter/report, they may call me at 702 435-7270.] <BR>
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