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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Pressure Headaches And Nausea, Post Shunt Insertion. CT Scan Showed Migraine And Given Fentanyl. Spinal Tap Needed?

Hi...I need advice about NPH. Having pressure headaches and severe nausea 3 years post shunt insertion. CT scan showed it's in it's place...ER doc did only that test and decided I was having a migraine, gave me fentanyl and reglan, something for nausea and IV fluids. I was able to rest then and it helped take the edge off the pain. Went home with the headache. Doc called and said if my headache gets worse again to come right back for a spinal tap. I just wonder if that sounds like reasonable advice. Thanks.
Mon, 14 Oct 2013
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Neurologist,  's  Response
Hi,
Thank you for posting your query.

The advice sounds correct. In your case, the most likely cause of headaches could be migraines, which can be treated with appropriate medications.

However, it is important to exclude shunt infection, which can cause meningitis leading to fever, headache and vomiting. A spinal tap can help us diagnose shunt infection, by showing increased WBCs and protein in the cerebrospinal fluid and low sugar. Appropriate antibiotics can help cure this condition. In addition, the shunt tube would also need to be replaced.

I hope it helps.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Senior Consultant Neurologist
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Pressure Headaches And Nausea, Post Shunt Insertion. CT Scan Showed Migraine And Given Fentanyl. Spinal Tap Needed?

Hi, Thank you for posting your query. The advice sounds correct. In your case, the most likely cause of headaches could be migraines, which can be treated with appropriate medications. However, it is important to exclude shunt infection, which can cause meningitis leading to fever, headache and vomiting. A spinal tap can help us diagnose shunt infection, by showing increased WBCs and protein in the cerebrospinal fluid and low sugar. Appropriate antibiotics can help cure this condition. In addition, the shunt tube would also need to be replaced. I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology) Senior Consultant Neurologist