Brief Answer:
Not necessarily unusual for circumstance

Detailed Answer:
Good morning. My name is Dr. Dariush Saghafi and I am a neurologist in the XXXXXXX Ohio region. I would like to offer a suggestion to answer your present question. I understand that your daughter who is handicapped since birth suffers from CNS complications of toxoplasmosis and was shunted early on. She was revised at age 12 and approximately 4 days ago was shunted due to an emergency situation which you did not specify. Though the surgery went well per the conversation you had with the neurosurgeon, you have since come home with your daughter and she has been sleeping and tired to the point of excess in your opinions. You are concerned with this behavior.

Obviously, having to take your daughter in for emergency shunt revision must've been difficult and very scary to say the least. You didn't say what the problem was but my guess is that either she was complaining of severe and unusual headaches, had nausea/vomiting that could not be controlled or developed without obvious cause, was lethargic or difficult to arouse, had high fever, or a combination of all the above. In other words there was a shunt failure.

If in fact, this was due to an infectious cause then, usually the entire activity of the brain, or as we might say generically (the CNS; Central nervous System) is blunted and it is not uncommon to find patients very tired, lethargic, and sleepy even though they've been successfully treated with antibiotics, shunt revisions, etc. They do not feed well in the initial postop days and it takes up to a couple of weeks and sometimes longer for the system to RESET or recalibrate itself. In other words, I believe it's early on at this point to make any judgements as to what else might be going on if the neurosurgeon told you that the shunt revision itself was a success.

Similarly, even if not an infectious cause-- let's assume it's just a shunt failure due to valve defect or other mechanical problem then, what will happen is that pressure will build up in the brain to the point of causing the person to become unstable with headaches, nausea/vomiting, lack of energy, and will begin to sleep quite a bit. The shunt may be fixed rather quickly since I'm sure you noticed right away something was wrong and took her in, however, still the inertia of the system would still be expected to dictate a recovery time even after pressure was relieved and the shunt was once again placed into operational order.

In addition to the above reasons to explain her degree of over-tiredness let's not forget that she would've been sedated under general anesthesia for the procedure. I am assuming her lungs and kidneys are normally functioning but if for some reason they were not then, that could be just another added reason why she could be tired. In other words, anesthesia may still be lingering under that scenario. And even if the anesthesia were completely cleared out with normal pulmonary and renal function again, the stress of the situation to be placed under anesthesia and then, recovery could take a bit more than a few days to completely bounce back.

Therefore, in my opinion so long as your daughter's status is stable in terms of the shunt revision itself and she has no fever, is not nauseous or vomiting, and is otherwise moving all limbs equally (though tired or sleepy) then, I don't think there is excessive cause to worry right now. I'd give it another few days and continue giving her whatever medications she might be on in terms of antibiotics and so forth.

It certainly wouldn't hurt to contact the surgeon just to let them know that you are concerned that she hasn't bounced back yet to normal and see what their response may be....I don't see that as unreasonable for parents who are as dedicated as you are.

You could also offer a lot of stimulation during the times she is awake in terms of conversation and whatever physical activity she can tolerate. I wouldn't necessarily try to keep her awake 24/7 since her body probably needs some degree of extra sleep and quiet just to recover from whatever it was that caused her to need the shunt revision in the first place. However, she were awake I see nothing wrong with trying to keep her engaged and active in things. Perhaps, she could write letters to her teaches and classmates about how much fun she's having on her unexpected vacation from school. You could also try and engage her in some homework and other normal activities, have her friends come over if that's appropriate and assuming there is no risk that she may become infected by others or vice versa.

If on the other you notice that she has even a low grade fever that is persisting despite good hydration and perhaps some mild amounts of Tylenol or aspirin, is complaining of low grade headaches, not picking up in her appetite much, not moving all the limbs the way you'd expect she'd move them from before the procedure then, those should be red flags that require immediately review by the doctors and I wouldn't hesitate to take her back to the ER for another look see. They will get another shunt series by CT in all probability and run some more blood tests as well as urine to be sure that her infectious status is negative and then, go from there.

I wish you the very best and do not hesitate to contact me directly with further questions regarding this or any other medical issue you may have for your daughter or yourselves. You can always get specific questions directly to my attention by using the following link:

bit.ly/drdariushsaghafi

If any of the above information has been helpful to your situation I'd appreciate some brief written feedback of the same and I'd be very grateful if you CLOSE THE QUERY on your end if you have no further questions or comments as well. Otherwise, I look forward to answering any other concerns you may have.

This query required 46 minutes of physician specific time to review, research, and document for final draft and envoy.

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