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Symptoms due to increased pressure in cranial cavity in a child - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Brain and Spine
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
User :   I have a 3 year old daughter who was treated for hydrocephalus at the age of five months. She has a right side VP shunt. She was doing fine since last 2 years. However, in Sept 2010 she had a bout of vomitting and suspected shunt malfunction. All her reports, scans (CT and MRI), CSF fluid etc were totally normal. She developed 3rd cranial nerve palsy which was treated by giving steroids and her plasy is totally cured now. However, she has been having various regular (almost after every 2 weeks) episodes of 2-3 vomitting, tiredness, nausea feeling and wanting to sleep all the time. Can you please suggest what the problem is.
Doctor :   Hi
Doctor :   Dr here
User :   hi
Doctor :   let me read ur query
Doctor :   these symptoms are due to increased pressure in the cranial cavity
Doctor :   Is she on any medications ?
User :   but her CT scans and MRI are totally normal
User :   no. we just gave her ondem and lanzol when she vomitted
Doctor :   though the CT & MRI are normal, the slight elevation of Pressure can bring about the symtoms
Doctor :   and minimal elevated pressures may not be that evident on radio imaging
Doctor :   has any Lumbar punture done to estimate the CSF pressure ?
User :   we have shown her to various neurologist / surgeons, they are all do not have a clear answer. she has a programmble shunt, they once changed the pressure from 70 to 55 and later they decided to increase the pressure to 90.
Doctor :   and since these symptoms occur episodically, this means that she could be having cycles of elevated CSF Pressure
User :   a lumbar puncture was done to check for any CSF infection
Doctor :   when was this done ?
User :   in Sept 2010 when she was seriously ill and have the 3rd cranial palsy
Doctor :   ok
User :   is vomitting a necessary symptom of shunt malfuntion or increase pressure
User :   she is not vomitting all the time. she has a nausea feeling and vomits only whatever she has had to eat.
Doctor :   yes, nausea, vomiting, irritability, sleepiness, are symptoms of elevated CSF pressure
Doctor :   just nausea, and vomiting, thats only occasional could be due to dislike for the food or other reasons
Doctor :   but its the constellation of symptoms and signs that i mentioned earlier that indicate high CSF pressure
User :   but it is cyclical after every 2-3 weeks since last 3 months
Doctor :   i understand, that is i why i mentioned that this rise is due to slight increases in CSF production or changed pattern of drainage
Doctor :   you need not be worried about them
Doctor :   what i would suggest is addition of a medication that can reduce secretion of CSF, when such episodes occur
Doctor :   you can consult with your neurologist for prescription of such medication, and if it may help her
Doctor :   ar u following my advice ?
User :   yes.
User :   can it be something related to gastro
Doctor :   It could be, due to gastritis, or something else like gastric reflux
User :   does that cause excessive sleepiness
Doctor :   but such issues will not be having irritability, sleepiness, lethargy, weakness etc
User :   will her programmble shunt needs a further revision
Doctor :   It depends on the opinion of her neurologist,
Doctor :   As i dont have the whole details about the shunt , and the lack of findings of physical examination i will not be able to comment on the need for revision of the shunt
User :   we have consulted almost 6-7 renowned neurologist of the country and no one has a clear answer to our problem.
Doctor :   but at present, she needs a minor care for her symptoms
Doctor :   what were their inferances ?
Doctor :   what did they say ?
User :   some felt it is a temporary blockage of the shunt but most of them felt that it has nothing to do with her shunt but is due to some gastro or other infection which is not being detected.
User :   they asked us to keep a tab on her food habits but still she fell ill since the last week.
User :   she has had 2 CT scans and 3 MRI in the last 3 months and all of them were normal.
Doctor :   i would advice you to have an expectant approach and be calm
User :   her ultrasound of the abdomen was also fine
Doctor :   and do not worry much about the symptoms
Doctor :   You can ask the neurologist for a medication that can reduce the CSF pressure to some extent
User :   we worry that these episodes are probably effecting the brain and development of the child
Doctor :   and this medication can be given as needed (as and when she has the symtoms)
Doctor :   unless she has severe elevation of pressure and causes hospitalisation and complications, there is no need to worry
Doctor :   and that is not expected as of now
Doctor :   since the shunt is in place higher elevation would be prevented
User :   can such problem go away on its own
Doctor :   yes
User :   thanks doctor, we will talk to our neurologist. thanks for your help. hope things sort out
Doctor :   I Hope that too
Doctor :   you are welcome
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