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What Causes Headaches After Placing VA Shunt?
Question: My 29 yr old daughter had a VA shunt placed in 2011. She had relief from IH for about 2 yrs, and has had unmanageable headaches and whooshing since then. Her shunt patency tests have been normal and she shows no high pressure symptoms in her eye exams but she just had a spinal tap and the pressure is high.
What would be the reason for this? And any suggestions for next step
What would be the reason for this? And any suggestions for next step
Brief Answer:
Cardiac evaluation should be done.
Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
If your daughter would have presented to me as an outpatient,I would have enquired in the first place that why she was made to undergo a VA(Ventriculoatrial) shunt rather than a VP(Ventriculoperitoneal)shunt as peritoneum is a preferred distal site for shunting rather than atrium and atrium is selected only in cases of abdominal infections and other intra-abdominal complications.
However,for now,since shunt patency is confirmed,next step is to see for the proper functioning of distal target site,which is atrium of heart in the present case.So,cardiac evaluation should be done for ruling out the following disorders-
1)Heart failure
2)Endocarditis
3)Valvular dysfunction
4)Heart wall abnormalities
5)Pulmonary hypertension
6)Arrhythmias
An Echocardiography and an electrocardiogram(EKG) should be evaluated.Also,
patency of major veins like jugular and subclavian should be ensured.
Here,you mentioned that spinal tap revealed a high CSF pressure.As there is no papilledema in eyes,I would like to know what is the exact CSF pressure,measured on spinal tap.Please upload the latest CSF reports too.
Waiting for your follow-up.If you have no further questions,please close the thread-rate it and write a review as your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Cardiac evaluation should be done.
Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
If your daughter would have presented to me as an outpatient,I would have enquired in the first place that why she was made to undergo a VA(Ventriculoatrial) shunt rather than a VP(Ventriculoperitoneal)shunt as peritoneum is a preferred distal site for shunting rather than atrium and atrium is selected only in cases of abdominal infections and other intra-abdominal complications.
However,for now,since shunt patency is confirmed,next step is to see for the proper functioning of distal target site,which is atrium of heart in the present case.So,cardiac evaluation should be done for ruling out the following disorders-
1)Heart failure
2)Endocarditis
3)Valvular dysfunction
4)Heart wall abnormalities
5)Pulmonary hypertension
6)Arrhythmias
An Echocardiography and an electrocardiogram(EKG) should be evaluated.Also,
patency of major veins like jugular and subclavian should be ensured.
Here,you mentioned that spinal tap revealed a high CSF pressure.As there is no papilledema in eyes,I would like to know what is the exact CSF pressure,measured on spinal tap.Please upload the latest CSF reports too.
Waiting for your follow-up.If you have no further questions,please close the thread-rate it and write a review as your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Shanthi.E
She had severe abdominal problems so they did the VA. I don't have the report with me but the pressure was 25 and her most recent patency test was 17 and shunt was deemed working fine. The headaches are debilitating at this point and we are trying to get an appt with her neurologist at XXXXXXX but they are not available until Sept. We just don't know if this is a normal effect of having the shunt or there is something terribly wrong such as a blockage at distal target.
Brief Answer:
Cardiac evaluation and MRI Brain with MRV.Rule out primary headache.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing the details.
In the background of no papilledema in the eyes,it can be presumed that the high csf pressure is not longstanding.Though,shunt patency is normal.But still,cardiac evaluation and evaluation for the patency of major veins as mentioned above should be considered.Please discuss with the surgeon who performed the shunting regarding these evaluations.
Also,Magnetic resonance imaging(MRI) and Magnetic resonance venography(MRV) of brain should be done as sometimes venous thrombosis can manifest with headache and raised intracranial pressure.
Thirdly,Other primary causes of headache like Migraine(Migraine sometimes can be chronic also with atypical features) or Tension type headache should also be ruled out,as high csf pressure not severe enough to cause papilledema,is slightly unusual to cause such terrible headache.
ENT specialist's opinion to rule out sinusitis should also be a part of the evaluation here.
Hope I have answered your query.If you have any further questions,I shall be glad to answer else,please close the thread-rate it and write a review.Your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Cardiac evaluation and MRI Brain with MRV.Rule out primary headache.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing the details.
In the background of no papilledema in the eyes,it can be presumed that the high csf pressure is not longstanding.Though,shunt patency is normal.But still,cardiac evaluation and evaluation for the patency of major veins as mentioned above should be considered.Please discuss with the surgeon who performed the shunting regarding these evaluations.
Also,Magnetic resonance imaging(MRI) and Magnetic resonance venography(MRV) of brain should be done as sometimes venous thrombosis can manifest with headache and raised intracranial pressure.
Thirdly,Other primary causes of headache like Migraine(Migraine sometimes can be chronic also with atypical features) or Tension type headache should also be ruled out,as high csf pressure not severe enough to cause papilledema,is slightly unusual to cause such terrible headache.
ENT specialist's opinion to rule out sinusitis should also be a part of the evaluation here.
Hope I have answered your query.If you have any further questions,I shall be glad to answer else,please close the thread-rate it and write a review.Your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Shanthi.E
You have been very helpful, thank you. My daughter is very overweight. Do you find that weight loss is helpful with IH? Does the weight play any part in the high pressure? I read differing opinions on this issue.
Brief Answer:
Obesity is related with Idiopathic intracranial hypertension.
Detailed Answer:
Hi XXXX,
Thanks for appreciating and being in follow-up.
Obesity has a definite association in cases of Idiopathic intracranial hypertension.In your daughter's case though,idiopathic intracranial hypertension is not the established diagnosis,still weight reduction efforts should be made wholeheartedly.Weight reduction might help lowering down intracranial pressure.It is to be observed,for sure.
Hope I have answered your query.If you have any further questions,I shall be glad to answer else,please close the thread-rate it and write a review.Your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Obesity is related with Idiopathic intracranial hypertension.
Detailed Answer:
Hi XXXX,
Thanks for appreciating and being in follow-up.
Obesity has a definite association in cases of Idiopathic intracranial hypertension.In your daughter's case though,idiopathic intracranial hypertension is not the established diagnosis,still weight reduction efforts should be made wholeheartedly.Weight reduction might help lowering down intracranial pressure.It is to be observed,for sure.
Hope I have answered your query.If you have any further questions,I shall be glad to answer else,please close the thread-rate it and write a review.Your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Prasad
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