Tuesday, September 4, 2012

The Results from the Neurosurgeon

What an early day once again.  Dad stayed home while I made the drive to the neurologist to talk about the results from Dad’s spinal tap.  I met with Dr Kenneth Reichert a neurosurgeon on the same team as the neurosurgeon who performed Mom's brain operation last November.

The results are in and he is positive for hydrocephalus.  Here is the official report for those of us who like to read medical bumbo-jumbo:

TECHNIQUE: 0.69 mCi of of indium 111 DTPA was intrathecally injected 
followed by 30 minute imaging of the thoracolumbar spinal canal. 
Subsequently, 4, 24, 48 and 72 hour anterior, posterior and lateral planar 
imaging of the brain was performed. 

FINDINGS: Initial 30 minute post lumbar puncture images of the spinal canal 
do not demonstrate any the leak/extravasation of tracer. Four hour images 
demonstrate physiological tracer uptake within the basal cisterns, sylvian 
and interhemispheric CSF spaces; there is also prominent lateral ventricle 
activity. 24 hour images also demonstrate prominent lateral ventricle 
activity, minimally decreased from 4hrs. There is some physiological tracer 
uptake tracking along the cerebral convexities. 48 hour images demonstrate 
further migration of CSF along the cerebral convexities however there is 
decreasing but persistent tracer uptake within the lateral ventricles. 72 
hour images do demonstrate near resolution of activity within the lateral 
ventricles with additional tracer migration along the cerebral convexities. 
However, there is no significant sagittal sinus activity even at this time. 
This delayed CSF migration pattern with tracer reflux into the lateral 
ventricles is suspicious for communicating hydrocephalus. 

IMPRESSION: There is delayed CSF migration pattern with persistent tracer 
reflux into the lateral ventricles up to 48 hours, suspicious for 
communicating hydrocephalus. 

Day of spinal injection; typical; you see the dye in the brain and down the
spinal cord.  Nothing significant - as expected
Four days later, should not being seeing signs of dye; still showing
about 6.29 inches down the spinal cord and in the brain.  

But what does this mean?  Yes, there’s excessive spinal fluid on the brain and it is possible it is affecting his short term memory.  Here is the breakdown form the doctor.

Dr Kenneth Reichert
Dad’s a candidate for surgery whereby they would place a shunt in his brain.  The procedure would mean he would probably be between the hospital and rehab/nursing care for up to two months while he recovers. Then he will require assistance at home for an unspecified amount of time.

The surgery has a 70% chance of improving dad’s walking – which isn’t really a concern right now.

The surgery has a 60% chance of correcting incontinence – which Dad isn’t experiencing right now.

The surgery has a 40% chance of correcting short term memory loss – of which Dad has a significant loss.

If we do nothing, Dad will decline and eventually require nursing care. 

If we do surgery there’s a 40% chance that he’ll be able to eventually get back on his own.  However, he will require assisted living and other protocols in place to always monitor how he’s doing.  Dad will always be a fall risk, too.  With surgery, there’s a 60% chance he’ll require nursing care starting immediately and for the rest of his life.

The odds are not exactly in his favor. 

This Friday I will meet with the neuro-psychologist and find out their take on Dad’s condition.

I spoke to Dad today about it for about an hour or so.  The first thing he said was, “well tell the Doctor I don’t hear any sloshing around and I’ll let him know when I do!”  That’s my Dad – always quick to shrug things off with a joke.  But he realizes the serious nature of this issue.  He is prepared for his life to change drastically IF he chooses the surgery.  I told him we will make the decision as a team.  He told me he wouldn’t want it any other way.  

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