Index to Chiropractic Literature
Index to Chiropractic Literature
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ID 18861
  Title Chiropractic care and management of an adult hydrocephalic patient with ventriculoatrial and ventriculoperitoneal shunts: a case report [poster presentation; the Association of Chiropractic Colleges' Thirteenth Annual Conference, 2006]
URL
Journal J Chiropr Educ. 2006 Spring;20(1):60-61
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Peer Review Yes
Publication Type Meeting Abstract
Abstract/Notes Background: Hydrocephalus is excessive accumulation of cerebral spinal fluid (CSF) in the brain. It may result from genetic inheritance (aqueduct stenosis) or developmental disorders such as those associated with neural tube defects, including spina bifida and encephalocele. Complications from premature birth such as intraventricular hemorrhage, disease such as meningitis, tumors, traumatic head injury, or subarachnoid hemorrhage blocking exit from the ventricles to the cisterns may also cause hydrocephalus. Using a shunt apparatus for hydrocephalus is the neurosurgical procedure most frequently used to divert the flow of CSF from a site within the central nervous system to another area of the body where it can be absorbed. In this case, the shunt types used are ventriculoatrial and ventriculoperitoneal.

Objective: The purpose of this case report is to discuss the successful chiropractic care and management of an adult patient with congenital hydrocephalus.

Clinical features: A 23-year-old male presented with low back and bilateral knee pain of 10-month duration. He informed the student extern and faculty clinician at Palmer College’s Community Outreach Clinic that he had shunts in his head and neck due to congenital hydrocephalus. A full health history and complete physical exam, including the knee, was performed. Full spine and chest radiographs were taken. There were no significant abnormalities noted on physical examination, orthopedic and neurologic examination or chiropractic spinal analysis. Radiographs showed CSF shunts along the cervical spine going into the chest and peritoneal cavities.

Intervention and outcome: A working diagnosis of low back pain due to lumbar and pelvic subluxations was made. Cervical and thoracic subluxations were also noted. Over a period of 8 weeks, the patient was treated with low force adjusting techniques using Thompson drop technique in the thoracic, lumbo-pelvic and right tibia areas and Activator method and/or Thompson drop technique in the cervical area. Primary areas that were adjusted were right ilium, T5, C2 and right tibia. The schedule of care was 2 times per week for 2 weeks, followed by one time per week for 6 weeks, then re-evaluation of the patient’s progress. The patient had missed several appointments but has been responding well to this adjusting approach and schedule of care.

Discussion: Avoidance of occluding and damaging the catheters located within the scalenes and sternocleidomastoid muscles was of the utmost importance. Techniques to be avoided for cervical spine, in this case, would be any rotational type of adjusting, such as supine diversified (formerly known as modified rotary break) or Gonstead cervical chair. No manual pressure should be placed on the catheter due to possibly occluding and damaging the catheter or flow valve shunt causing mechanical failure. For the thoracic, lumbar and pelvic adjustments, any reasonable adjusting technique could be used.

This abstract is reproduced with the permission of the publisher.
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