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Neurology (Expert Forum)
Did Spinal leak cause brain aneursym and feet-leg nerve damage?
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Did Spinal leak cause brain aneursym and feet-leg nerve damage?
by Diane71161, Sep 26, 2006 12:00AM
I‘m 45 year old, very active, fit & healthy woman until December ’05 when I injured my back. My MRI showed degenerative disc disease at L4 – L5 secondary to diffuse bulging at L-4. Left paracentral encroaching upon the L-5 root. Mild facet arthrosis noted at L-5- S1. Also lumbarization at the S1 level. I had 3 cortisone/steroid epidural injections. 1st one helped. 2nd one left me w/headaches & nausea, (go away after I vomit clear fluid), calves & feet jerking & cramping. 3rd one needle resisted insertion, I felt & heard pop-w/ pain. 2 days later watching tv. I couldn’t see how people were talking. Told Dr. of symptoms each visit. I was told nothing to be worried about. I started having explosions in my head when I would fall sleep. First electrical charges, then a big explosion woke me. Felt confused. Called Dr.-told I was transferred to pain management & I had to wait 2 months to see him. I developed feet pain in left ankle & inside of foot. Was put on crutches by family Dr. & my right foot went out. My face & head swelled. I called pain doctor about explosions & I was sent to ER. They did a CT & found a small basilar tip aneurysm. Also did spinal tap & found no blood. Next day headache worsened & I was in bed for a week. At my appointment spine Dr.gave me a bloodpatch. He said in his opinion it wouldn’t help. It helped immediately! I had a spinal leak for about 3 months. Could this or epidural shot cause brain aneurysm & nerve damage to feet? Had Angiogram & go see neurologist Oct. 2, my feet pain will also be addressedl. Still feel dazed, keep forgetting. Thank you!
Doctor's Answer
by CCF-Neuro-M.D.-SH, Oct 04, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms you describe are consistent with a low pressure CSF headache. When the CSF pressure drops the brain sinks into the foramen magnum (hole at the bottom of the skull) and this pressure can cuase some symptoms. Most commonly, imbalance, headaches, nausea, vomiting and extremity pain/numbness/weakness. When the injection was performed I suspect the "pop" was the needle passing through the Dura (outer lining of the brain/spinal cord) or the leak occured with the lumbar puncture. Sometimes a puncture site in the Dura will remain open and convert to a chronic leak (although this is rare) Evidence that would support this is Dural enhancement on MRI, Low opening pressure on repeat LP, Indentified leak on CT myelogram and/or improvement with a blood patch procedure. The brain aneurysm was not caused by the injection and and may or may not be contributing to your symptoms. Concern should be raised in someone with "posterior fossa" symptoms (nausea.vomiting, "explosions", etc) about tip of the basilar syndrome and TIAs/small strokes arising from the aneurysm in your basilar artery. You are doing the right thing by getting the angiogram of your cerebral vessels. I would also recommend an MRI of the brain to look for evidence of small embolic strokes and any sign of chiari malformation (sinking of the brain as described earlier). I would also recommend an EEG to evaluate the possibility that the "explosions" may represent seizures.
I hope this has been helpful
The symptoms you describe are consistent with a low pressure CSF headache. When the CSF pressure drops the brain sinks into the foramen magnum (hole at the bottom of the skull) and this pressure can cuase some symptoms. Most commonly, imbalance, headaches, nausea, vomiting and extremity pain/numbness/weakness. When the injection was performed I suspect the "pop" was the needle passing through the Dura (outer lining of the brain/spinal cord) or the leak occured with the lumbar puncture. Sometimes a puncture site in the Dura will remain open and convert to a chronic leak (although this is rare) Evidence that would support this is Dural enhancement on MRI, Low opening pressure on repeat LP, Indentified leak on CT myelogram and/or improvement with a blood patch procedure. The brain aneurysm was not caused by the injection and and may or may not be contributing to your symptoms. Concern should be raised in someone with "posterior fossa" symptoms (nausea.vomiting, "explosions", etc) about tip of the basilar syndrome and TIAs/small strokes arising from the aneurysm in your basilar artery. You are doing the right thing by getting the angiogram of your cerebral vessels. I would also recommend an MRI of the brain to look for evidence of small embolic strokes and any sign of chiari malformation (sinking of the brain as described earlier). I would also recommend an EEG to evaluate the possibility that the "explosions" may represent seizures.
I hope this has been helpful
Member Comments (1)
by GLOW29, May 03, 2008 11:13PM
A related discussion, CSL was started.
