Need opinion CSF leak

25 male

Aug 2009, developed severe headache, followed by light sensitivity, vertigo, and even some minor confusion.

Neurological exam perfect

Doc order mri- with contrast of brain this was done about 3 weeks after onset of headaches - vertigo was normal expect poorly seen right vertebral artery flow

2 weeks after that had neck angiogram CT was normal the right vertebral artery was small but congenital

10-27-09

Lumbar puncture, for possible chronic meningitis. Was not the case All labs normal (microbiology) and all cell counts normal expect protein was 47. Normal range 15-45. I will note they forgot to take opening pressure (idiots) and it took near 2 hours to drain 4 vials, had to tilt the table, cough ect.

Doc said migraines. But migraines don’t happen everyday, and no family history.

Saw, upmc headache expert. He is telling me intracranial hypotension, due to tap, and I am allot better during the night, and upon wakeup.

I am still IFFY on the diagnosis, but he said this even before I told him about the LP length, and protein.

He is suggestion 30 days of rest and fluids, even though leak may be at 5 months.

After that he is suggestion CT myleo.

I am going to refuse the myleo. Why have another leak?

I want to know your thoughts on a Heavily T2-weighted MR myelography link below if unfrimlar.

http://www.neurology.org/cgi/content/abstract/73/22/1892

Also what are your thoughts on a blind blood patch (not knowing where leak may or may not be)?

And general thoughts on diagnosis.

I will say it’s on and off. I will have days where I can be up almost the whole day, with just mild headache. Water does seem to help, and talking a nap, does too, when I have a bad headache. Some days are just plain bad all day.

Is a blood patch dangerous?

any other ideas on a diagnosis if this is wrong? What about a bad artery or anyerousim in my head? Or is that unlikely at 5 months? Heart? Please ANY other suggestion?

[Abhijeet Ghosh]

Dear Motox,
I can understand as how frustrating it can be at times.
I would keep my provision diagnosis as  " Spontaneous Intracranial Hypotension Syndroms (syndromes)". Maybe that's why you get relief with water drinking and with small naps...

Regarding the "Blood Patch" treatment, it is a good form of treatment for dealing with small leaks. But the sole discretion lies to the treating surgeon as what treatment he needs to offer to his patient. So i would suggest you to have a re-discussion with your treating doctor.

As far as the fact that your treating doctor is giving you a lot of opinions, i would suggest you to have a second opinion with another doctor because the present situation shows that he is a little lost in your case.
So discuss and then let me know by posting.
If you got  any doubts, please post them as individual question, so that i can answer them point wise.
Regards