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Paralyzed after spinal operation. Getting neck pain and headache. MRI normal. What's wrong??

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Neck pain shunt problems after MRI


My husband became paralyzed after a spinal operation in XXXXXXX 2011. He had problems with spinal fluid leaking so he had a brain shunt inserted on the left side of his head in Aug. 2011. He's been in therapy for months & was going home on Tuesday Oct 4. On Thursday Sept. 29 his therapy doctor ordered an MRI of his back "just to make sure everything is ok." After the MRI my husband immediately had a headache & stiff neck, shoulders & arms. We think the MRI messed up the brain shunt.

The next morning, only the neck pain remained. The neck pain is positional, that is, it does not hurt when he is reclining in his wheelchair or lying in bed, but sitting upright in his wheelchair is very painful. Warm compresses help, but the neck pain does not go away.

The Drs and therapists tell us there are knots or trigger points in his neck & massage them, but it does not help. His Dr. stuck needles in the knots and added numbing medicine to them, but it did not help.

The doctors tell us that the shunt is fine and is working correctly. My husband did not go home on Oct 4. Nothing is improved after 9 days--the doctors are stumped. He is getting headaches behind his right eye.

On October 7, he had an MRI done of his neck and head. Nothing showed up unusual.
The shunt is readjusted back to what it was--.5. He can sit upright without pain. We are thrilled.

Today, October 8, in the morning the neck pain returned, with him unable to sit upright without pain again. His neurosurgeon came and changed the shunt setting to 1. It did not help. He will return tomorrow to change it back to .5.

Everyone is stumped that he was fine before the first MRI and had instant neck pain right after the first MRI and that the pain is positional--happening only when sitting upright. It seems that something is wrong with the shunt, but the MRI showed no problems with it. He cannot go home until his neck pain is gone. Please help, thank you.
Posted Mon, 16 Apr 2012 in Brain and Spine
Answered by Dr. Sudhir Kumar 12 hours later

Thank you very much for writing in detail about your husband's problem.

My opinion below is not final, as you would understand that without examining the patient and reviewing the reports, it is difficult to do that.

Shunt surgery is a common surgical procedure, usually undertaken if there is hydrocephalus (excess water accumulation in the brain- inside ventricles of brain) or if there is increased intracranial pressure. Shunt can be thought of as a method of diverting the brain fluid from brain to peritoneal cavity (abdomen).

In your husband's case, everything seems to be OK, except for his neck pain, for which there does not seem to be any obvious cause. However, after going through the description of the pain (I must admit you have given an excellent account of the pain!), I think it is a "low pressure" headache.

In this condition, the sufferer has severe headache and neck pain, which is located at the back of lower part of head (occipital region) and neck. Pain is maximum when in upright posture (sitting or standing) and subsides when reclining (sleeping posture). Patient may have accompanying symptoms such as nausea, vomiting or giddiness. The cause of pain in this condition is low CSF pressure. As I mentioned earlier that shunt surgery is done in cases of elevated intracranial (CSF) pressure (to lower the CSF pressure), in some cases, the pressure may become too low (lower than normal), resulting in headache and neck pain.

Neurosurgeons approach this problem in several ways. They may try to adjust the parameters in the shunt. Some surgeon prefer to insert a "variable pressure" shunt. In these shunts, shunt pressure can be adjusted as desired in an OP setting also. In rare cases, shunt may have to be removed also.

Other causes of neck pain could also be intermittent shunt obstruction. Cervical spondylosis has been excluded by a neck MRI, which is another important cause of neck pain.

I have tried my best to provide my insights on your husband's problem, though I feel slightly hampered without the ability to examine him. I suggest you discuss these issues with your neurosurgeon. I am sure the problem of neck pain would soon be solved. I have seen some similar cases recently and they have all improved well. Do write back to me if you have any further queries.

Thanks and regards,

Dr Sudhir Kumar MD DM
Consultant Neurologist
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