C6-7

[bklk]

Hello,
In September I presented in the ER with severe headaches that followed a upper respiratory infection.  LP showed 23 WBC-90 lymphocytes.

MRI’s all have been normal
MRA normal
Subsequent LP’s to look sacrcoidosis, herpes PCR, etc. have all been normal since October but really bad headaches remain.  

The only medicine that helps is Prednisone.  

Pain is back and top of my head, left arm and what seems to be trigeminal nerve on the left side of my fact, burning.  All or one at a time worse with activity, slowly improved with rest.

Finally a neurologist who has been following me suggested a spine MRI as I had lumbar problems requiring surgery in the past.  
MR found a moderated C6-7 central herniation with mild effect on subarachnoid space.  

How likely this could be causing headaches???  
I looked at a anatomy book and see the trigeminal nerve has a spinal element.  Could some way the trigmeninal nerve pain result from herniated disc or result in CSF flow changes??  
Far fetched??   I know the left arm pain, shoulder and outer arm correlate well with C6-7?  
But the face pain?  

How possible is it that the herniated disc represents a CSF leak, do they have at all similar MRI apperance?  


What would be your thoughts on this.
Thanks

[CCF-Neuro-M.D.-CS]

I cannot make a clinical diagnosis of your headaches, but I can make some suggestions

It sounds like you might have had a viral meningitis back in spetember (based on the CSF results, and lack of other causes)
Not uncommonly headaches can persist for weeks to months after, and can be resistant to medications

Prednisone helps as almost any kind of headache feels better with presnisone, but it is not a long term solution

I cannot be sure about the MRI without seeing it, but if the report is correct, that degree of bulging of the disc is unlikely to be causing chronic headaches

The spinal NUCLEUS of the trigeminal nerve extends down into the deep posterolateral part of the spinal cord, and would be very unlikely to be affected in isolation.

A routine MRI study will not show a CSF leak; other tests including an MRI CINE flow study, a CT myelogram or radionucleotide tracer studies can identify CSF leaks.

If your headache has a postural component (worse when you stand up), and you had a traumatic lumbar puncture (ie several attempts), you may have a small CSF leak, which has specific but successful treatment options (like a patch over the leak)

In any case, it sounds like your headaches are severe enough for a second opinion with a headache neurologist. If you are in the area, The Cleveland Clinic Headache Center could help you.
Good luck

[ginnybean]

I have disc bulges at c5&c6 with nerve avulsion a few mm from the spine at c5-7 levels and long thoracic nerve damage verified by EMG all this from being rearended and pushed into another car, i was the passenger. im awaiting a referral from my ortho doc to a neurosurgeon. I had a cervical rib removed 4wks prior to my MVA but the EMG confirmed the nerve damage was due to the wreck not my rib resection as my ortho seemed to believe...id love for one of these docs here to respond as I can never get a ? posted to respond to this but I will tell you that since that mva i have had headaches and i am 30 and never had headaches unless i had a sinus infection. I have had facial pain, tingling, and numbness on the left side. Sometimes my ear and jaw hurt as well as shoulder pain,forearm swelling, burning in back of arm, pain in scapula, scapular winging, muscle spasms on the side and back of neck with spasms in my traps and up the back of my head. my pt said these were causing the headaches.

Have you had a EMG? This painful but necessary test will pinpoint in most cases if done by a competent neurologist what and where the damage is. My disc bulges were discounted by my ortho as not causing my problems. I think he was convinced that my vascular surgeon nicked my LTN during the rib resection. He told my husband that many people have these bulges and are asymtomatic and the MVA may or may not have caused them. I have a cervical MRI from 7/02 that shows a normal healthy cervical spine but he seemed to think i was trying to put the blame on the MVA so he ordered an EMG and NCV's on both sides to put me at ease. Well I had the test done Friday and the results are above as stated by the neuro who did them so if you have not had an EMG insist on one. It could mean the difference between getting well or suffering needlessly. Im sorry this post is so long but I have learned to be your own advocate or doctors can ruin you. Good Luck