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Have chronic migraine and pseudotumor cerebri. VP shunt placed. Is it possible of shunt to be infected?

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Neurologist, Surgical
Practicing since : 1997
Answered : 65 Questions
I have chronic migraine (nearly a daily occurence) as well as pseudo tumor cerebri. I have a VP shunt (placed 12/2008, revised 12/09 due to blockage & 12/2010 due to faulty valve) and am pretty good at telling what is causing my pain. However, for the past 24 hours I've had a severe headache (probably migraine) with persistent nausea & chills. My temp is normal, although I'm loaded on meds which also reduce fever. Today I've had (at home) Oxycodone, Tylenol, Phenergan, Bendadryl, and Toradol (all oral except Toradol which I injected as instructed by my doctor at Johns Hopkins). I'm a Kaiser Permanente patient so can access care 24/7 but am often rushed off to the hospital & they find that I simply have one of my persistent migraines. I feel too sick to go in just because someone is advising I do so to cover themselves legally. Given my chronic conditions, should I be concerned? Also, is it possible for my shunt to be infected without having had shunt surgery in a year & a half? I don't think it's a blockage because those symptoms came on gradually & this is sudden.
i also forgot a couple things. 1 - Toradol injection almost always make pain tolerable, did nothing tonight, that's only happend very rearely. 12 - I'm havint trouble typing as the night goes on... could be tired & affected by all the meds, but given symptoms thought i should mention. 3 - my temp is actually a full degree & a half lower than usual. i have chills, heat flashes, but my toes & fingers are freezing. although i physically CAN tuck my chin to my chest, it hurts too bad to force it, not in the neck but it makes the headache worse. if i had meningitis i'd know, right?
Posted Sun, 5 Aug 2012 in Stroke
Answered by Dr. Shivakumar S. Kupanur 14 hours later

Thanks for posting your query and the detailed history.

With the provided information, it is very unlikely that your headache is due to shunt malfunction. However, it can not be excluded at all. But, the possibility is very rare.

Acute meningitis presents with severe bilateral frontal headache, high grade fever, with or without neck stiffness. But, with your history even this possibility looks unlikely, as your temperature is normal and also you do not have any other associated symptoms of migraine like photophobia.

Your headache seems most likely due to acute onset of migraine precipitated due to subclinical infection or stress.

I would suggest you to wait and watch for next 24-48 hours. Continue with your migraine medication. In case it does not settle, then you might need investigations to find out the cause, so that proper treatment can be initiated.

I think I have answered your query. I will be available for follow up queries if any.


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