Intracranial Hypertension and Cerebral Blood Clot Posted: 03-20-08 02:07am
I was diagnosed with intracranial
hypertension (pseudotumor cerebri) last
year after months of undiagnosed symptoms
and almost going blind due to papilledema.
The MRI showed a blood clot, I believe in
the back of my brain, though I'm not
certain of the position. My neurologist
isn't good at explaining things. My
diagnostic opening pressure for the lumbar
puncture overflowed the gauge, so it was
over 50.
I then had a lumboperitoneal shunt put in
and was told to take a baby aspirin a day.
The pressure was okay for a while with
only an occasional headache...but as with
before the surgery, the back of my head
often constantly ached. Then I went
through a few weeks in pain, three or four
days in particular where my headache was
horrible and the back of my head and my
neck ached like crazy. My scalp felt kind
of...tingly? Burning? But then it went
away and went back to only an intermittent
headache. I recently had my shunt valve
adjusted (perhaps overadjusted) because
the pressure was in the low 20's.
Even without high pressure, I have that
nagging aching and occasional burning in
the back of my head. Last week at my
neurologist, I told the doctor I would
like another MRI to check on the clot, and
she said it wasn't necessary. I asked her
if the aspirin would dissolve the clot and
she said no that it would stop new clots
from forming and the one I have from
enlarging. She apparently intends to
leave it there. When I told her about the
aching back of my head, she told me that
you never feel blood clots in your head.
So my questions are:
1) Can you really never feel clots in the
brain? They couldn't be pressing on
something and causing aching or burning or
something?
2) Why would I have a few horrible days
and then go back to feeling mostly okay?
It's not like I did anything different in
my daily life. Could it have been the
clot bleeding a little bit or something,
and then it stopped?
3) Last year my neurologist/surgeon
questioned the neurologist on duty at the
MRI's judgment about my MRI. She saw
nothing wrong with it, but he was
confident it was abnormal. She mentioned
that that part of the brain is usually
apparently vague or something, though she
admitted to not be an expert at reading
MRI's. Given the apparent vagueness and
nature of the matter, could what was
called a blood clot not actually be one?
Could it be something else?
4) My grandmother on my father's side had
to have brain surgery in her later years
because of "tangled arteries" in her
brain. I don't know the medical name for
it and can't find out, but could such a
condition possibly be hereditary/increase
someone's chances for it?
|
antigone
Moderator
Joined: 27 Jan 2008 Posts: 918 Location: IL
Thanks: 45
Thanked:16
Posted: 03-20-08 18:18pm
Your grandmother most likely had an
arteriovenus malformation (AVM). This is a
malformation of the vessels in the head
and they become intertwined with each
other and resemble knotted spaghetti.
A clot could be causing pressure in the
back of your head. The cranial vault or
skull, is an enclosed case with enough
room for the brain, vessels and CSF. If
something else is in this enclosed vault
the result will be pressure on the brain
tissue. This, in turn, will result in
neurological deficits.
I would seek a second opinion. One of the
first things I saw in my patients with a
shunt malfunction was a persistent
headache. Have you seen a neurosurgeon or
only your neurologist? The only way to
find a malfunction in a shunt is to check
pressures and MRI. Go to a neurosurgeon.
Who put your shunt in? Perhaps that is the
doctor you should consult about the
headaches. A neurologist generally has
less experience with these types of things
than a neurosurgeon. I hope you will
pursue this.
|
fiehumbuggery
New User, Becoming EHEALTHy
Joined: 20 Mar 2008 Posts: 2
Posted: 03-20-08 18:47pm
Yes, I think AVM that it's most likely
what she had as well. I looked into that
a great deal last year when I was trying
to figure out about my headaches. What I
want to know, however, is whether or not
the vague blood clot they said I had has a
higher chance of being an AVM due to
genes/heredity.
My neurosurgeon and my neurologist are the
same person. I believe she may primarily
be a neurosurgeon, and a pediatric
neurosurgeon at that. No real idea why I
was sent to her, but I was told she's a
specialist in IH.
Last week I went back to her about the
pressure, and she did xrays to ensure my
shunt was still in place, which it was.
Then she tapped my shunt to measure the
pressure, and it was about 22 or so, so
she adjusted the shunt to drain off more.
I think I may be having slight low
pressure at the moment due to
overcompensation.
I know that blood clots can cause
increased pressure, but would the pain be
more localized in that case? I.e. if you
have a clot in the back of the head, would
the rising pressure make the back of the
head especially hurt (more than the rest
of the head), or would the pressure always
spread out and affect the entire head?
|
antigone
Moderator
Joined: 27 Jan 2008 Posts: 918 Location: IL
Thanks: 45
Thanked:16
Posted: 03-21-08 00:40am
The pain may be localized but my patients
complained of generalized headaches. A
clot anywhere in the head can cause
problems. As I said, anything that takes
up space in the enclosed vault can lead to
problems. The pressure of the clot is
different than increased ICP due to CSF. A
clot would cause the brain tissue to be
displaced. That can cause neuro deficits
and headaches. ICP changes can also result
in headaches but can be accompanied by
vomiting. I would get another opinion. A
neurosurgeon does the actual surgeries and
a neurologist is a doctor that looks at
the medical end of problems with the
nervous system and brain-MS, seizure
disorders, Alzheimer's, etc. If this were
me I would find another neurosurgeon and
get another opinion. I would try to go to
a university based medical center and get
another opinion. I hope this helps.
