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Neurology (Expert Forum)
CSF Pressure/Herniated Disks
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CSF Pressure/Herniated Disks
by Deb9637, Mar 27, 2007 12:00AM
49y/o F 5'11"/190lbs. No prev meds/drugs/liquor/smoking. 3 yrs w/neuro "episodes" beg. with rapid buildup of immense head pressure, preceeded/accompanied/immediately followed by a VERY stiff neck. Hearing fades; is replaced by whooshing noise; depth perception abnormal - nothing I think in physical reach actually is; legs/arms tremor (not violent)have NO control over what they do; Legs won't work right; Feel far away/numb and tingly all over; This fades in 5/7/10 minutes and I'm "normal" again. Happens several times a day/may go several days without it happening. NEVER when sitting/laying down.
Always upon rising - no matter how slowly. Testing all normal Several head MRI-Visual Field, VER , EEG's, EKG's, Holter Monitor, Stress Test, Cerebral Angiogram , Massive blood works (Anti thrombin3 deficiency/Beta 2 Glcoprotien 1 antibody), no MS, no Lupus, LP's - several both sitting/laying - opening pressures 250-320mm H2O - XRay guided LP's x 2 laying- open 25 and 27 respectively; Original dx PTC w/1000mg Diamox daily -taken in the am w/good success. Nephrologist recommended discontinuing after severe bouts w/kidney stones. Referred to neurosurgeon for shunt. Absence of pailledema, Visual Field loss/debilitatng headaches - wouldn't put a shunt in. Cervical/thorasic spine MRI to rule out a dural tear. Findings -C5-6 level,disk herniation is identified appears to be central and compresses on the cord centrally in the left paracentral region/well visualized. Cord displaced posteriorly - anterior/posterior dimension of canal measures 5 to 6mm. C4-5 level, A focal disk bulge in the central location, slightly to the right paracentral region also in contact w/cord and the anterior/posterior dimension of canal 7 to 8 mm. Impression: Central disk herniation/left paracentral abnormality/canal stenosis with myelopathic signal increase in the cord.Cord shows slight flattening. No features to suggest dural tear. Can this finding compromise the CSF flow and cause the above symptoms? Will ACDF eliminate these surges of pressure and neuro symptoms?
Always upon rising - no matter how slowly. Testing all normal Several head MRI-Visual Field, VER , EEG's, EKG's, Holter Monitor, Stress Test, Cerebral Angiogram , Massive blood works (Anti thrombin3 deficiency/Beta 2 Glcoprotien 1 antibody), no MS, no Lupus, LP's - several both sitting/laying - opening pressures 250-320mm H2O - XRay guided LP's x 2 laying- open 25 and 27 respectively; Original dx PTC w/1000mg Diamox daily -taken in the am w/good success. Nephrologist recommended discontinuing after severe bouts w/kidney stones. Referred to neurosurgeon for shunt. Absence of pailledema, Visual Field loss/debilitatng headaches - wouldn't put a shunt in. Cervical/thorasic spine MRI to rule out a dural tear. Findings -C5-6 level,disk herniation is identified appears to be central and compresses on the cord centrally in the left paracentral region/well visualized. Cord displaced posteriorly - anterior/posterior dimension of canal measures 5 to 6mm. C4-5 level, A focal disk bulge in the central location, slightly to the right paracentral region also in contact w/cord and the anterior/posterior dimension of canal 7 to 8 mm. Impression: Central disk herniation/left paracentral abnormality/canal stenosis with myelopathic signal increase in the cord.Cord shows slight flattening. No features to suggest dural tear. Can this finding compromise the CSF flow and cause the above symptoms? Will ACDF eliminate these surges of pressure and neuro symptoms?
Doctor's Answer
by Forum-M.D.-SH, Apr 17, 2007 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 that you describe are of autonomic nervous system dysfunction. The autonomic nervous system (sympathetic and parasympathetic) has many jobs including maintaining our blood pressure when we stand, regulating heart rate, regulating pupil size, gut motility, etc. The particular spell that your describe is classic for a rapid drop in blood pressure with standing (similar to orthostatic hypotension). There is a battery of test that are required to diagnose this condition specifically, including a tilt-table test and a autonomic test battery (which includes heart rate repsonse to valsalva and deep breathing). The findings in your cervical spine are concerning, but could potentially explain your autonomic symptoms. Some autonomic fibers (the decending fibers) travel alond the cord and can be compressed with a disc or other myelopathy. It depends on the severity of the injury if you will recover after your spine is surgically decompressed. If the cord is damaged to much for too long you may develop myelomalacia and the symptoms may not improve. The more likely senario is that you will have some relief with surgery, if not totally cured.
I hope this ahs been helpful.
The symptoms that you describe are of autonomic nervous system dysfunction. The autonomic nervous system (sympathetic and parasympathetic) has many jobs including maintaining our blood pressure when we stand, regulating heart rate, regulating pupil size, gut motility, etc. The particular spell that your describe is classic for a rapid drop in blood pressure with standing (similar to orthostatic hypotension). There is a battery of test that are required to diagnose this condition specifically, including a tilt-table test and a autonomic test battery (which includes heart rate repsonse to valsalva and deep breathing). The findings in your cervical spine are concerning, but could potentially explain your autonomic symptoms. Some autonomic fibers (the decending fibers) travel alond the cord and can be compressed with a disc or other myelopathy. It depends on the severity of the injury if you will recover after your spine is surgically decompressed. If the cord is damaged to much for too long you may develop myelomalacia and the symptoms may not improve. The more likely senario is that you will have some relief with surgery, if not totally cured.
I hope this ahs been helpful.
As you know, a correct diagnosis is the base for a correct treatment especially the surgical one. I feel, from your description, that your case lack that at least about the PTC.
After years of medline review, I admit of not hearing about a mean pressure fo the CSF, unles you are talking about a neuro trauma cases in an intensive care with open skull monitoring? even then I doupt the 320?? But, we nevere stop learning and I will be very gratifull if you could get me the reffrence of that from your neurologist , so I could read/analyze it myself.
We, only look at the opening pressure of the CSF and 250 mmH2O is the top normal level for the hight and weight you mentioned!
So, if you dont have issues passing urine (like an urgent need to rush to the WC, straining to start , a feeling of incomplete emptying the bladder, or drippling..ext) then I would say that all your symptomes/CSF pressures are inkeeping with INTRACRANIAL HYPOTENSION which could be spontaneous or secondary and even the anti-thromin 3 deficiency and Beta 2 Glycoprotien 1 antibody which are part of a hyper-coagulable state could be due to this disease , because central venous thrombsis reported as a complication of Intracranial hypotension!..So you need a different approach than the one used for PTC
Back to your questions:
Could the CSF flow be comprimised from these herniated disks? No
And do you think the surgery will help with the surges of pressure in my head and these neruological issues? yes and no
yes, If the central herniation and cord flattening/signal at the C4-5 level and C5-6 level,+ the canal stenosis are significant per the eye a neuroradiologist and a neurosurgeon because neurologically we are facing a disease could confuse the picture of a cord compression. And yes if they could look directly for a dural tear which is usually at the thoracic level , but rarly could be in the skull bas level!!
Do you think the problem I am having is solely from these herniations? already answered
Bob
I do so appreciate another "take" on what may be going on with me neurologically. I am seeing a new Neurologist in the morning for a 2nd opinion....and I am now armed with a whole host of questions.....and thanks to your input and some research on my own....I feel much more informed, educated and equipped to ask the "right" questions. Thank you again Bob. You're very generous to share your "retirement" with those of us seeking additional opinions and answers. God Bless......Deb
Bob