Tuesday, December 06, 2016

Vision Loss due to Hydrocephallus - VP Shunt Revision

Its is really hard to get notified from a 2 and half yrs baby about the failure of the shunt (VP Shunt) which has been already placed.

The symptoms are :
1. Headache 
2. Vomiting
3. Sunset eyes 

The next immediate step would be to take the baby for CT-Scan, which would show the accumulation of the excess fluid in the babies head. When we fail to get notice of these things,the excess fluid pressure would cause some damage to the nervous originating from brain, which inturn may lead to disabling of the feature related to the affected part of the brain.

There are cases that the VP Shunt may fail permanently or on a temporary basis (works on and off,in this case it may not get detected in the CT-Scan) 

Below is the case of shunt failure of a 2.5 yr baby

Around in the month of september, the baby had vomiting and headache complaint..and whatever you feed her gets thrown out with a span of 20 - 30 mins
so we didn't want to take the risk and we took the baby for the CT-Scan next day and the scan result showed us No Hyderocephallus and we were happy and the vomiting and headache stopped


Later on after a month later, 21st Nov, the baby again had a complaint of the headache and vomiting, and we took her to the Scan center next day.
By this time, the vomiting stopped and she had very normal diet on this day. The scan result showed us it was a normal.



So here is what happened, the shunt was functioning on and off, which was not detected in ths CT-Scan. Now the  baby was almost weak, since from the previous day what ever she had eaten was vomited.

The following day morning the baby was normal, she ate only limited food, whatever she had asked was given. Around 11 am she again had vomited and complaint of headache. We tried feeding her with liquid and eatables she liked.. but this did not help..even a 10 ml of water she takes in was thrown out.



Around 4 pm in the evening she started crying and was not manageable , so we took her to her pediatrician nearby, it was around 6 pm in the evening, he examined her and said that the pulse rate are dropping and the eye's are droopping and these are certainly the symptoms of the Shunt Failure.

He advised us to reach the hospital immediately not even wasting a second.. we also rushed her to the hospital, while on the way we are keeping are awake...and interacting with her to check her responses... in-between we were struck in the heavy traffic around (7 to 7 30 pm). We now decided to call the hospital about the baby's condition to our Neurosurgeon, (luckily my wife had the hospital phone number in her memory and need not search in the phone.) on calling to the hospital
we came to know that, it was already informed by Pediatrician, and they said "Yes we are aware of it...and where are you.."

On reaching the Hospital, my wife took her running to the Emergency, the duty doctor's put her on the basic statistical checks and then started asking about the baby's history..and then they informed the neurosurgeon. Now the baby's eye's closed was not responding and after a few minutes her hands and legs became stiff and in a stretched position, until that she was able to hear our voice and responding, after this condition she collapsed..they took to the CT-Scan and the Surgeon told that the shunt is not functioning and need to do the Shunt Revision immediately.



 
So it took 40 mins for the operation and was completed by 9:30 pm. Now she was moved to the Pediatric ICU, and was slowly coming out the anesthesia. Despite having a good sleep, she woke up intermediately (may be due to pain). she did not open her eyes, but was responding to us.

After the Operation

After 12 to 14 hrs the baby was shifted to the ward for observation, there was IV in the hand. Now she was able to open the eyes but could not see us, so she got frightened and slept on my shoulder only, then we slowly stared speaking to her, she was responding well, but not able to sit,stand or see...and also not eating or drinking anything. By this time my wife as doing all the finding in the net of similar cases and what and whom to meet next....lot of confusion among us also

We got discharged from the hospital, the surgeon said that it should all get to normal slowly, once you get back home. After coming home she started drinking water through spoon, and eating bread soaked in milk all the activities were carried out by putting her on the bed only.






Discharge summary.

Checked for the Ophthalmologist.


  We made sure that, the vision part is not affected from the aspect of eye and it was checked with one of the Pediatric Ophthalmologist, anyway we had to wait for the MRI scan of the brain.


Next we had to take the MRI Scan of the Brain, but our only worry was the baby had already was not eating and we had to put her to sedation using syrup for the eye check ups, and she did not sleep even after giving the sedation syrup, and the only way was to go for anasthesia through doctor. Make sure that you leave the scan
center once the baby is wakes up after the anaesthesia is over

Finally the MRI of the Brain was done, the report said that there was change of pattern of the Brain image  



After consulting the MRI of the Brain with a Pediatric Neurology doctor and  second opinion with the Neurology doctor, we are advised that the nerve which connects the brain to the eye was not functioning properly, this was because when we rushed her to the hospital on 22nd Nov, she went into a state called "decerebration", which meant that, due to pressure of the CSF fluid in the head, some of the parts of the brain and its nerves lost the blood circulation and the baby goes to a state in which she streches her legs and hands and the body becomes stiff

The doctor's say that these nerve's usually should heal or come back to normal when the blood circulation to these nerves start flowing as normal, and it may take upto 3-weeks to 3 months or 6 months time. So till then we need to observe the baby's vision activity how well she is progressing, like.. what colors she is able to see, how far she can see, what all are the objects she is able to identify...lot more things..

Nothing is confirmed until...Now.

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