Your comments can be useful to many patients. It helps to justify the very difficult and the repeated trials to get a correct shunt.
My answer of my question about grading is the following:
It is a very severe grade having great impacts on health and quality of life. This answer of course is subjective. To put an objective evidence, I mention my eight years of difficult struggle for relief and to get my CSF adjusted. These included five operations, high costs and travelling abroad for treatment. I have been very sure that it is a curable illness. CSF pressure fine adjustment is currently a challenge, in spite of intensive research and advanced technology. To be cured CSF should be optimum, and risks to achieve this target might be disasters. Compromises are not good targets because of CSF sensitivity. A minor distance away from optimum causes significant symptoms. Also a sustainable cure is very difficult. So my repeated trials over all these years can reflect the amount of suffering of patients similar to me. I am very sure that without my clinical awareness and medical background I will not be able to proceed so persistently. I am also very sure that there are many ICH patients undiagnosed all over the world. Also I am sure that there are many hydrocephalic shunted patients who are not optimally adjusted. I believe that this applies to developed countries as well as developing countries.
For improving diagnosis and treatment of hydrocephalus we have to try to answer the simple relevant questions as well as sophisticated queries. A vision is needed.
Grading looks a very simple question, and I am not trying to let it out with my friends. I believe that it is a very relevant and very important question to ask. First it will justify implanting a shunt. The second is that it might solve lot of controversy and conflicts between different neurosurgeons. The other related point here is the clinical outcome after shunting. I will try to discuss it with my colleagues later on. So evaluating the amount of suffering of patients before shunt and the clinical outcome after shunt are the two indicators that help us to prove that shunting and holing brains are justifiable ways of treatment. This also would involve all other risks. Personally I like the hole in my brain and I am proud of it as it offers me important relief. I believe that we should stop talking about less important things and concentrate on more important points. Our efforts should be in the same summing direction.
The overall in-hospital mortality rate for ICH in Sagrat Cor Hospital of Barcelona stroke registry was 31%, but this varied from 65% for multiple topographic involvement, 44% for intraventricular ICH, and 40% for ICH in the brainstem to 16% for ICH in the internal capsulebasal ganglia. These data suggest a difference in the clinical spectrum and in-hospital mortality according to the site of bleeding (Acta Neurol Scand 2002; 105: 282-288)
Thank you Dr Adria. The problem is hydrocephalus and the diagnosis is intracranial hypertension (ICH) and not intracranial Hge (ICH)since childhood but diagnosed very late when my age was 57 years. I am very sorry for not clarifying causing this confusion. As you know I am at a Hge risk during adjustment, but I am taking grading of severity as a reason to justify shunting operation
Respected Dr. Sunil,
Your answer clarifies to me very clearly the importance of using accepted abbreviations. This what Dr. Adria Arboix mentioned to me in his answer on the same question above. I will edit and correct my question immediately so that we will be talking about the same thing. I will put it "IIH" which refers to idiopathic intracranial hypertension.
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