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The patient is a 32-year-old patient
who was diagnosed with pseudotumor cerebri in 2004. At that time she
was sent to have papilledema, as well as increased opening pressures
at the spinal tap. She had a lumboperitoneal shunt placed at
that time. Her headaches improved after that surgery; however,
initially she was complaining of low pressure headaches, and then
those had resolved with times. She had recurrence of the headaches
and apparently when she was tapped her pressures were considered
high again, and at that time she had AVP shunt placed. Later on,
according to her, her VP shunt failed, and
around nine months ago she had to have it removed, and it had a
revision of her lumboperitoneal shunt, so at the time being she has
no enteroperitoneal shunt, and just lumboperitoneal shunt that has
been
revised. Since that surgery, she has done well initially; however,
she has been complaining of recurrence of her headaches. She had
several spinal taps that did not show any significant increase in
her pressures, and she had an eye exam that did show papilledema
despite the headaches. She is also complaining of budding around the
lumboperitoneal shunt tract. Otherwise, she is in good health.
DIAGNOSTIC IMAGING:
Outside CT scan of her head, as well as MRI scan of her brain was
reviewed. She does not have any venous occlusion.
RECOMMENDATIONS:
Discussed with the fact that at the time being she does not seem to
have any signs of increased intracranial pressure. We discussed with
her the need to determine whether her shunt is working or not. If
her shunt is not, I would not recommend any further surgical
intervention, and would refer her for evaluation and treatment of
her headaches. To determine whether her shunt is functioning
adequately, will obtain
Nuclear Medicine cisternogram, and then see her back for follow up
once that is obtained.
Radiology Report:
SHUNTOGRAM
CLINICAL INDICATION: 31-year-old Caucasian female with history of
pseudotumor cerebri. The patient has an LP shunt.
TECHNIQUE: Under fluoroscopy a sterile lumbar puncture was performed
by the neuroradiology service. 1.92mCi Indium-11 pentetate were then
injected into the thecal sac. Delayed images of the abdomen were
obtained in the anterior and posterior projections per protocol.
FINDINGS: Activity is seen in both kidneys and the bladder. This is
consistent with a functioning shunt.
IMPRESSION: INCREASED ACTIVITY SEEN IN BOTH KIDNEYS AND BLADDER
CONSISTENT WITH A FUNCTIONING LP SHUNT.
OUTPATIENT NOTE
(10/11/06)
The patient was seen today at the Neurosurgery Outpatient Clinic for
follow up. Since her last visit she says that her headaches have
improved and her pain over the shunt is not as significant.
ASSESSMENT/PLAN:
We discussed with her the fact that the shunt is working, that it
does not need to be removed, especially as it would put her back at
having recurrent papilledema and problems with her vision. She is to
continue follow up with her referring physician and we will see her
back for follow up in our clinic as needed.
BACK
© 2006 Nuclear Education Online
- Images courtesy of University
of Arkansas for Medical Sciences Dept of Nuclear Medicine.
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