Sunday, 20 October 2013

Spina Bifida and Hydrocephalus Awareness Week 2013 day 3- My Symptoms When Things Went Wrong Plus Useful Definitions

So far I've written about my birth and how I came  to have Hydrocephalus as well as the operations I had. Today I want to introduce you to some key terminology relating to shunts and hydrocephalus.. Anyone who has hydrocephalus is also very familiar with the terms shunt "blockage" shunt "failure"  and shunt "fracture"  . 
A shunt blockage occurs when the shunt is blocked with something , or when too much Cerebrospinal fluid (CSF) builds up in an area of the catheter (or tubing) the CSF flows through. shunt "failure" is when the shunt stops working, and shunt fracture is when the catheter gets damaged . 
I have had experience of all three of these problems with my shunt over the years . 

When I was 6, my parents noticed I had symptoms of really bad headaches and vomiting, so I was taken to hospital by them. Once there, my brain and abdomen were examined via a CT scan.  That didn't show anything so they did another one., which showed the catheter had become detached from the pressure valve and was lying , useless, in my brain  .That's an example of a fracture  I had failures and blockages at other times but can't remember how old I was at the time.  I know about what happened when I was 6 as it's in my medical history and my dad has told me. 

I felt so Ill, and the headaches and nausea were so intense I couldn't concentrate at school. 

Possible signs of chronic shunt blockage may include:

fatigue, general malaise, visual problems, behavioural changes, decline in academic performance, being just onot right» from the carer's point of view.

If a shunt blockage is suspected, medical advice should be sought from your neurosurgical unit within four hours of acute symptoms starting. In shunt infections, symptoms vary with the route of drainage. In ventriculoperitoneal shunts, the symptoms often resemble those of a blockage.

This is because the shunt becomes infected and the lower catheter is very often then sealed off by tissue.

There may be accompanying fever and abdominal pain or discomfort or redness over the shunt site. In ventriculo-atrial shunt infections, fever is present in most cases though often intermittently. Anaemia is frequently present, and sometimes skin rashes, along with joint pains.

In contrast to ventriculo peritoneal shunts, such infections may not appear for months or years after the operation when they were contracted.

Various tests can be carried out for shunt infections and medical advice should always be sought if an infection is suspected.

How are shunt problems treated?

Shunt blockages which are causing illness usually require an operation to replace or adjust the affected part of the shunt. Shunt infections are usually treated by removal of the whole shunt and a course of antibiotics before insertion of a new system. Modern approaches to antibiotic therapy mean that such treatment can be expected to succeed, in most cases.

Endoscopic Third Ventriculostomy

An alternative treatment may be a third ventriculostomy, where a small hole is made in the floor of the ventricle to divert the flow of CSF. This treatment, if successful, avoids the need for a shunt. However, not all types of hydrocephalus can be treated by this method and it is not available in all neurosurgical units.

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