  It was noted that the patient began to have an acute onset of headache pain after her shunt adjustment approximately a week and a half ago.  I had programmed her shunt back to 90 mmH2O at that time and confirmed it with an x-ray.  However, the picture of the x-ray was not the most desirable picture.  Thus, I decided to reprogram the shunt back to 90 mmH2O today and have the patient return to Sinai for a skull x-ray to confirm the setting at 90.  In addition, she told me that she is scheduled to see Dr. Y tomorrow, so she should followup with him and also plan on contacting the Wilmer Eye Institute to setup an appointment.  She should followup with the Wilmer Eye Institute as she is complaining of blurry vision and dimming of the lights occasionally.