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How to manage hydrocephalus?

Q: This is regarding my mother who is 62 years old now. One day she fell unconscious on the road 10 years ago. Thereafter we came to know that she suffers from hydrocephalus, and she went through her first shunt surgery. As the shunt pressure was not suiting her she went through some 5 surgeries in a span of about one month. She also was suffering from chronic subdural haematoma. So they drilled holes into her brain to remove it. This was done about three times during the same month. Slowly she recovered but was never the same. Thereafter she was doing okay and again 6 years ago she went through a revision of VP shunt because there were blockages in the shunt. Now since the last 4 months she has been complaining of headaches and also vomiting. Ocular gaze and movement disorders are very predominant and she requires some one to be around always. It subsided on its own but again it has started since the last 2 months and is troubling her off and on. As CT scan reports indicated everything normal, an MRI of the brain was done - The 3rd & 4th Ventrical are disproportionately prominent with slit like lateral ventricles without any significant periventricular ooze, Ischemic lesions in the right posterior frontal, anterior frontal periventricular regions and left centrum semiovale, encephalomalacia / gliosis in the left posterior frontal lobe, age related cerebral atrophy, left maxillary & bilateral ethmoidal sinusitis is also noted. She is always lying down and does not have motivation for doing anything and prefers to keep her eyes closed as well. No medicines have been prescribed except for Emset for stopping vomiting. Sometimes she vomits despite Emset. Along with this she has short memory lapses aswell. Ocular gaze and movement disorders are very predominant and she requires some one to be around always as earlier. She also suffered a massive heart attack 3 months ago without any chest pain. (Ischeamic Heart Disease, anterior wall akinesia, dilated LV, depressed LV function, LVEF=35%, Mitral Valve Prolapse, No mitral regurgitation, Intact IAS/IVS, No clots). The cardiologist has told us to continue medication for another two months and do an angiography next month and then an Angioplasty. A by-pass is ruled out in her case. Her fasting glucose level is 108. What do you suggest as desirable treatment for her?

A:As you will have gathered by now, she has an unfortunate series of medical problems - abnormal collection of fluid within the cavities of her brain, malfunction of the tube inserted at surgery to drain the fluid away, a clot outside her brain because the tube functioned too well and collapsed the brain, damage to her brain because of poor blood supply and, more recently, a heart attack. I feel you should follow the advice given by your doctors. They are doing a good job despite the many unfortunate problems.


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