neurosurgery question/shunt side effects?

[medstudent2005]

howdie

friend of the family was diagnosed with a brain cyst last yr and had surgery to drain it. no idea what caused the brain cyst, neurosurgeon doesn' t know. she felt weird for about 10 days, complaining of being tired and weak. then, 1 month ago, repeat scans showed that the cyst had recurred (initially it was 7 cm, recurred at 6 cm within 8 mths). She had a shunt placed on the right side, as the cyst is on the right side. Now she has been having possible neurologic vs psychosomatic sxs. I was just wondering if you guys can give some input: she says the whole of her face feels "tingly and numb." She also complains of increasing weakenss in bilateral lower extremities, with "tingling and numbness" mainly on the left side, but some similar sxs on the lower right extremity as well. She also says her vision has gotten quite blurred, and that sometimes she does not see certain letters when she is reading something. For instance, with the word "and" she may not see the letter "a" and she has to reposition her head to see it. She has also been feeling extremely tired. She has been to the ED, and they did a CT scan and "checked her out" saying everything was nl. She went back to neurosurgeon, who interpreted the CT from the ED, and said the shunt looked well positioned, it was working well, and he didn't see any problems. He also did not do a neurologic exam on her and told her he didn't know what her sxs meant and to go see her PCP. she is majorly freaked out. I sorta told her it was all in her head and to go see her PCP and have a complete neuro exam done, especially visual exam. i'm just a lowly med student, so just wondering if you guys think it could be psychosomatic, as her neurosugeon and ED reports indicate that everything is fine (but i dint think they did a thorough neuro exam)

merci

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[Idiopathic]

It was said best in Vertosick's book..."You're never the same once the air hits your brain."

I think that these might be expected sx/sy, given the nature of the Rx. BUT with that said, a focal neuro exam should definitely be performed, as well as a general inspection of the shunt (minor infection?)...honestly, the signs sound like more of a general problem that could result from minor swelling or hydrocephalus?? (anyone?) because they seem pretty general and are mixed (bilateral motor weakness, unilateral facial paraesthesia with contralateral lower leg paraesthesia).

The zebra here is brain stem pathology, I suppose. Not likely.

BTW, I am also a lowly medical student, and I just wanted to chip in a few pennies here. Please do not use anything I say to make any kind of Dx or Rx recommendation (at least not until after June 9 )

 

[scooter31]

I am not a doctor, let alone a neurosurgeon, so take my post with a grain of salt. I do, however, have 2 years of experience in a neurosurgery clinic, and have seens tons of shunt pts come through the door.

The only thing, since CT came back okay, is to maybe readjust the shunt pressure. Play with it, move it up or down, have her come in for weekly checkups, and see where that goes. Another thing that may come up, is a shunt tap to see if any infection has been introduced. Hopefully, it something as minor as adjusting the pressure, and if she's had the shunt for a year now and has never had it adjusted, it may be the time to do that. Hope all goes well with your friend

 

[medstudent2005]

hello

she's had the shunt in only for about 10 days. last yr, she was diagnosed with the brain cyst after having vague complaints then pretty much almost passing out at a supermarket. so she had the surgery to drain the cyst. then, it was followed, and about 1 month ago, the cyst recurred, so now she has the shunt in. she is very upset/scared/sort of depressed about having a shunt placed in her head, that she will have to have for the "rest of [her] life." Her complaints seemed somewhat vague to me, with bilateral lower extremity findings
(though more on the left side), including bilateral facial paresthesias (tingling/numbness), plus feeling of progressive weakness mainly in the b/l lower extremities and visual disturbances (all since the surgery), which don't completely fit in with a right sided shunt, unless she had major blood loss (which she says she didnt...i guess so the surgeon said). i mean, i would think if she had a major neurological problem, it would have happened more dramatically, though the visual disturbance is somewhat concerning (she also indicates having developed photophobia). anyhow, some input from neurosurgeons would be appreciated.

thanks

 

[doc05]

some input from neurosurgeons would be appreciated

you won't find any neurosurgeons on this site...

 

[medstudent2005]

yowsers, where oh where have the neurosurgeons gone?

 

[scooter31]

Theres a discussion forum on nsmatch.com, you'll find plenty of resident neurosurgeons on there. It's like the everyone forum, but turned down just a notch, so beware, but I bet you'll get someone to give you a good opinion on the matter.