February 17, 2014
In just a week, Jessica Brubaker went from noticing a slight vision problem to barely being able to see her fingers in front of her face. Neurosurgeon Mohamed Abdulhamid, MD, installed a shunt to drain excess cerebrospinal fluid.
Imagine you're a young, healthy high school teacher with great students, and working on a master's degree in a field you've always dreamed of making your career. Life is great.
Then one day you develop a weird headache, and it doesn't go away. A few weeks later, your vision is fading, and you don't know what's causing it.
Scary stuff? Oh, yes.
Jessica Brubaker, 31, can tell you all about it. The childhood development instructor at Boulder Creek High in Anthem, and graduate student at Grand Canyon University, was with her students when, out of nowhere, the headache hit.
"At first it was like a sinus headache, but in the back of my head," she said. "I'm not the kind to call in sick, so I scheduled a massage. That didn't help, so I went to my doctor. He gave me a muscle relaxer."
When the headache didn't subside, the doctor prescribed two different antibiotics. The first made her sick, the second didn't work, and after that, "everything went downhill in a hurry," Jessica said.
She went to her nearby hospital emergency department (ED). They gave her a "headache cocktail" and sent her back to her doctor. He told her to keep taking the antibiotic.
Desperate, she went to the John C. Lincoln North Mountain Hospital Emergency Department, where a neurologist started tests to find out what was really causing the headache.
'Crazy High' level
Doctors performed a lumbar puncture, tapping into her lower spine to drain cerebrospinal fluid. Normal fluid pressure levels range from 10 to 20 cm of water, she said. Hers was at 51, "crazy high," she said.
Jessica Brubaker's eyesight started improving soon after neurosurgeon Mohamed Abdulhamid, MD, operated to install a shunt.
The hospital neurologist diagnosed idiopathic intracranial hypertension and referred her to neurosurgeon Mohamed Abdulhamid, MD. Elevated intracranial pressure can cause papilledema, optic disc swelling that can lead to vision disturbances and potential blindness.
Dr. Abdulhamid recognized that Jessica required immediate action.
"Her swollen optic nerves were becoming dysfunctional. In a week she went from noticing a slight vision problem to barely being able to see her fingers in front of her face," Dr. Abdulhamid said.
"She certainly couldn't drive or go to work," he continued. "She was literally going blind in front of my eyes. If nothing was done, she could have become permanently blind."
Luckily, Jessica said, "he didn't tell me that, at least not right away. He only told me we needed to take care of my problem as quickly as possible, but he didn't scare me. I really appreciated that."
Idiopathic Intracranial Hypertension
This is a mixed group of conditions, explained neurosurgeon Mohamed Abdulhamid, MD. The condition is characterized by intracranial (within the skull) pressure greater than 20 cm of water, without evidence of a brain mass, infection, enlarged ventricles (brain cavities) or hydrocephalus (abnormal accumulation of fluid in the central ventricles).
Although its causes are not fully understood, several theories attempt to explain it including:
- A mechanical theory suggests increased abdominal and central venous pressure could decrease cerebrospinal fluid resorption (re-absorption) and increase intracranial pressure.
- A hormonal theory suggests fat cells convert the male hormone androstenedione to the female hormone estrone, causing hypertension and raising pressure inside the skull.
Elevated intracranial pressure can cause headache, nausea, vomiting and papilledema, as well as optic disc swelling that can lead to vision disturbances and potential blindness.
Dr. Abdulhamid ordered an urgent lumbar puncture to relieve pressure in Jessica's brain and on her swollen optic nerves. "This was my fourth lumbar puncture," Jessica said. "I feel like a real trooper for enduring them!"
Dr. Abdulhamid scheduled surgery to install a permanent shunt. Shunts divert cerebrospinal fluid into another region of the body, such as the abdominal cavity, where it can be absorbed. One-way valves in the shunt maintain normal fluid pressure.
"I installed the shunt," Dr. Abdulhamid said, "and my surgical colleague, Brad Doxey, MD, laparoscopically inserted the far end of the shunt tube into her belly. His laparoscopic skills are amazing. They allowed for a faster recovery, reduced postoperative pain and discharge from the hospital the day after surgery."
Jessica started regaining her eyesight soon after the shunt was installed, and has progressively improved ever since. "It's not back to where it was before the problem started," she said, "but it's much better than it was right before they placed the shunt.
"By now," she added, "I can read. It takes effort because it seems as if bits of my visual field are missing. I can spend a lot of time looking for the cursor on my computer screen. But I'll take it! I'm not blind. There are a lot of things you don't want to lose, but for me, eyesight is at the top of the list. I feel awesome."
For more information, please visit JCL.com/neurosciences.
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