seizures after programmable shunt pressure turned up?

[avfistula]

My wife had 4 brain surguries last year. The last 2 were for holes in her sinus. Between these sinus surgeries her surgeon turned her programmable shunt up to its max, and since then I have noticed a decline in her ability to think, and she developed a couple of seizures after her last surgery. Could the decline in her short term memory and thinking ability as well as her seizures be caused by the increased ICP from the shunt? The surgeon said he would turn down the shunt, but he was hesitant because of the hole in her sinus and he was thinking that a fluid accumulation could increase if he turned it down. It just seems like to much of a coincidence to me that her mental status has declined and she developed some seizures after he turned up the shunt. It has been 11 months since her last surgery, and nearly 6 months since her last seizure.Any advice would be appreciated.

[John Kenyon, CNA]

Hello -

It seems reasonable that a mechanically-caused increase in ICP would probably be responsible for your wife's altered level of consciousness. Elevated ICP is often the cause of such symptoms. While there is of course some practical purpose to increasing the shunt's pressure while the sinus surgeries heal, if it results in a decreased LOC then there has to be some other way to deal with the after effects of the sinus surgeries, and since the was done based on a "what if" and not on any actual increase in pressure due to drainage from the sinuses into the interior of the skull, it actually seems to make little sense to have let the shunt pressure at maximum when it would have been just as easy to simply monitor your wife's progress and response to the surgeries instead of just pre-emptively trying to avoid complications. A more involved, pro-active approach would have made more sense. I hope by now something has been done to address this. If not, I would definitely argue for a dial-down of pressure, even if it meant keeping your wife in the hospital for a day or two to see how things went.

I hope this is helpful. Best of luck to you both. Please keep us updated.