Hydrocephalus:  So how much pressure is high enough? Speaking of CSF of course…

Hydrocephalus:  So how much pressure is high enough? Speaking of CSF of course…

Pressure…a thing that applied in any situation, in varying amounts, has different effects.  Say, for example, the amount of “pressure” your boss puts on you at work or that you most likely put on yourself, will have a different effect than your screaming child throwing a tantrum.  There’s a build up of emotion associated with it, and given the right amount, will either cause you to lose the plot or fizzle away before you reach that point.

Likewise, I think of CSF pressure in the same way.  In a physical sense, the more build up you have (especially if left untreated), the more harm it causes.  Babies for example, still developing, will have an increase in their head circumference…they have room to grow.  (This doesn’t mean that it affects them any less).  Adults, on the other hand, are not so “lucky” since there is no more room for growth.  An abnormal increase in cerebrospinal fluid causes pressure that pushes the brain against the inside of the skull.  As you can imagine (or not) this will cause inconceivable pain (the kind of pain understood by anyone with Hydrocephalus).

Of late, this has become a numbers game.  The normal range is between 10mm Hg and 15mm Hg with the patient lying on their side.  However, I’ve also seen the upper-end being given as 18mm Hg or even 20mm Hg.  In 2013, the Lumbar puncture I had done yielded my pressure at 21mm Hg.  The surgeon who requested this test, was ready to insert a shunt if I had relief following the procedure.  However, I had one of those nasty headaches which lasted for a few days (apparently “normal” after a lumbar puncture…as I’ve recently been told).  I attribute part of my pain, to the number of times they tried (6 to be exact) before they actually got the needle where it needed to be.

Note to self: Never let an inexperienced trainee do this procedure unless you’re prepared to be a human pin cushion.  They will work on your nerves – literally!

A week later…I had total relief once the pain subsided.

Simply coughing or bending down to pick something up from the floor, delivered pure agony.  The surgeon I saw at the time, told me that my pressure was high but not high enough especially since he’s seen patients with “pressures of 40mm Hg and even 60mm Hg!“.  (I wonder how true this is).  If I was feeling as bad as I was with a pressure reading of 21mm Hg, I don’t even want to think what these poor souls were going through.

A friend and fellow Hydro Warrior, Kelly Conover Varga, has had to endure so many operations in a short space of time.  With a patent ETV (the hole is open), her LP gave a 25mm Hg result.  High enough to warrant further surgery.  So…there’s build up of CSF regardless of the fact that her ETV is open.  A build up of pressure just 4mm Hg more than I had a few years back.

This all leads me to think that, the amount of CSF build up, is different for each person and our TOLERANCE thereof cannot and should not be benchmarked on someone else’s.  Besides, some of us have bodies that can compensate and are able to “deal with it“, for whatever reason.  Same condition, different anatomy.

It makes me wonder though, how much pressure is high enough..?  Or, does it seriously depend on the surgeon you’re dealing with, and their personal “experience” despite them not physically being the one going through the pain?  Would that mean the level of trust you have in them is higher than the physical signs your body is throwing your way?  I suppose that can of worms is one for another post…

I’d be curious to know what’s the highest anyone else has measured at before having to go through another brain operation, because of it.



    September 2, 2017 at 3:08 pm Reply

    And what “they” forget in all “their” wisdom and number crunching is that we are humans whose normal may not even be on the range of normal. So a mid range reading is actually quite high for us. Stop focusing on numbers and listen to your patients!!

    • Skyewaters

      September 3, 2017 at 2:06 am Reply

      Amen to that!

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