Adverse Reaction to Graft

[ODAT]

Gropping for straws here. Mom is stll not 100%. She takes two naps a day and is still tired. Sleeping much better through the night. Sis is going to cut Ativan at night from 1mg to .5mg. Mom still has crying spells as well - a lot. I talked to her today and told her to cry when she really needs to and to try and control it when she can.

She said a while ago that she hasn't felt good since the graft was implanted. I have researched and have not found anything. Does anyone know if you can have a bad reaction to a graft? I wonder if it's the material the tubing is made of? I will call the vascular doctor in the interim.

[okarol]

Sorry ODAT - I don't have any insight as far as the graft, but will see if I can find anything. The thing I am thinking about is the crying. My grandmother had a stroke at 72 years old. One of the lingering effects was crying. The doctor explained that it's part of the brain that deals with emotions, and it wasn't something that she could control. She would cry over the smallest things, but she would say she was ok, and we became accustomed to not getting upset when it would happen. I only mention this because they may need to explore further (although your poor dear mom has been through so much intervention now, I imagine it's hard to sort out what has helped and what has made things worse!)
 

[ODAT]

You have helped okarol. Mom had a stroke about 11 months ago. She is going for an MRI today at 1:15. The neurologist ordered it. Being done without contrast dye since she had such a bad reaction when she had her heart stent. The crying has only been for the last month. I'm hoping she didn't have another one that was suttle - if there even is such a thing.

I have found that most grafts now are made of polytetrafluoroethylene and there reports of an allergic type reaction. Here are three articles I found:

"Department of Radiology, St Vincent’s Medical Center, Bridgeport, Connecticut, USA.
We present the case of a 54-year-old woman who presented with a one and a half-year history of persistent pain at the base of her right thumb. A scaphoid-trapezium interposition arthroplasty with polytetrafluoroethylene was carried out in an effort to improve function and decrease the patient's persistent pain. Approximately 7 years after surgery, she began to complain of increasing pain and radiographs showed extensive osteolytic changes, consistent with a foreign body giant cell reaction."

"Infection. All access devices can become infected. A Cimino fistula, because it does not introduce foreign material into the body, is only very rarely infected. Bacteria can be introduced when needles pass through the skin and into the graft. If bacteria become adherent to graft material it is difficult for the body’s defenses to control and eliminate infection. Signs of infection can be local or systemic. Local signs include redness, tenderness, and swelling over the graft. Systemic, or generalized symptoms of infection, include fever, chills, and a washed out, achy feeling. When these signs and symptoms are present it is important to be seen by a doctor to be sure that an infection is not present. If the graft appears to be infected, it can sometimes be treated with antibiotics alone. Most serious infections require removal of the infected device in addition to treatment with appropriate antibiotics.

Today, most of these grafts are made from polytetrafluorethylene (PTFE), the same material used for Teflon coatings and Gortex laminates."

"POLYTETRAFLUOROETHYLENE-INDUCED GRANULOMA AND BRAINSTEM CYST AFTER MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA: CASE REPORT.
CASE REPORTS
Neurosurgery. 61(4):E875-E877, October 2007.
Toth, Gabor M.D.; Rubeiz, Helene M.D.; Macdonald, R. Loch M.D., Ph.D.
Abstract:
OBJECTIVE: Microvascular decompression is commonly performed for medically refractory trigeminal neuralgia. A piece of polytetrafluoroethylene (PTFE) is usually placed between the trigeminal nerve and the blood vessel causing the compression. The procedure is effective and relatively safe, and PTFE is presumed to be inert. Reactions to PTFE are rare.
CLINICAL PRESENTATION: We report a patient who developed progressive neurological symptoms 5 years after microvascular decompression surgery. Imaging showed an enhancing cerebellopontine mass resembling a posterior fossa tumor with a large cyst compressing the brainstem.
INTERVENTION: Craniotomy was performed to decompress the cyst. Biopsy of the enhancing mass showed granulomatous inflammation. The patient underwent a second brainstem decompression surgery with placement of a catheter in the cyst connected to an Ommaya reservoir; she has moderate to severe residual neurological deficits.
CONCLUSION: This may be the first case of a severely disabling, space-occupying cyst resulting from a reaction to intracranial PTFE. Should this exceptionally rare complication be disclosed to patients or is it an idiosyncratic reaction unlikely to occur again?
Copyright (C) by the Congress of Neurological Surgeons"


If they don't find anything else and she is still like this, I'll look into this further.

[monrein]

I've no advice ODAT, just a hug.  I like Karol's thought about the stroke side effect and that might be worth asking about.  Just understanding WHY the crying happens so frequently would be a big relief for all of you.