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CSF Pressure/Herniated Disks
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CSF Pressure/Herniated Disks

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?
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Avatar_n_tn
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.
10 Comments
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Avatar_n_tn
also, Evoked Potentials all abnormal.
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Avatar_n_tn
Deb,
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
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Avatar_n_tn
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
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Avatar_n_tn
Many thanks  for these nice words, I'm so thankfull that God gave me this great  opportunity to be able to offer something  ...Wish you the best and a healthy life

    Bob
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178107_tn?1315951230
Bob, do you have any suggestions?  I went thru a two level ACDF (C5-C7) in Nov 2006, due to herniated disk. I have a titanium plate and screws.  I did not wear any kind of collar after surgery. Before my surgery I had some pain in my neck and pain and numbness in my right arm.  I was able to control it with mostly over the counter pain meds.   Since my surgery I am in more pain than before,  My doctor says that my post-op MRI and ct scan are normal.  I have constant burning pain in my neck and right shoulder and it runs down my arm, my pinky and my ring finger on both hands are numb.  I have some pain going down my left arm, but not as bad as the right one. The doctor seems to think that since my disk were totaly collapsed, my body is having a hard time accepting the bone grafts. It has been almost 5 months.  I have not slept in my bed since before I had surgery.  After laying down for about ten minutes both hands are totally numb.  So my recliner and I have become good friends.  I have had PT, it didn't help.  I have had two epidural injections at C6and C7, it has not helped.  I was schedualed for a third but since the others did  not help and my blood sugars have gone sky high, they have canceled the third one.  The doctor that did the injections said that I had a bulging disk at C4 and C5 that was pressing against a nerve  and it could be causing the burning in my neck and shoulder.  The doctor that did the surgery as never mentioned that.  I was on Percicet at first, until I started taking two at a time.  Then I was put on Meprozine 50mg/25mg, and it is not helping as well after taking it for almost two months.  I don't know what else they can do.  But I can't live my life in this kind of pain.  I have not even went back to work yet, and there is no way I can with the pain I'm in and the meds that I'm having to take for it.  I  am 44 and have two small children, ages 4 and 6.  We were late having children due to years of infertility, and now I can barely take care of them.  I have read several of your posts and you seem to have really helped  a lot of people.  Could I please get your opinion on my situation?  Thank you.
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Avatar_n_tn
Sorry Bev, I missed your post because I've been going to the patient to patient forum
  
    The right shoulder and neck buring pain sounds a clear neuropathic pain which is either to that unseen  disc?  or a complication of the multilevel anterior decompression, which is reported in the letreture (on one or both sides) due to a traction injury after improving the lordosis as well as having a better length of the cervical spinal column .
    while the postural numbness of the arms esp the 4th-5th finger which are innervated by the C8-T1 sounds more like either  a venous congestion related when lie down (something obstructing the blood flow from the area toward the heart)?...I know that a bilateral phrenic nerve (the nerve to the diaphragm) could be affected and if partial (subclinical) could decrease the breathing strength esp while lying which would rise the pressure in the chest and prevent blood flow from the neck...its all theuretical), or  simply its due to the traction issue I mentioned about C5 which is getting worse when you lie down.

   For the pain management , you will need  a proper identification of the cause before any thing then a plan to manage the neuropathic pain

  God bless
  Bob
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178107_tn?1315951230
Bob, thank you.  Do you think this is something that may require more surgery, with the issue at C4 and C5?  My doctor treats me like there is no way I should be in this much pain.  He keeps saying that my MRI and xrays look great.  Is there some other test that could be done that might show what is causing my pain?
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Avatar_n_tn
Hi,
  This post is a continuation of a disscussion on another thread...so you missed a big part of the history from her

   Thanks
   Bob
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Avatar_n_tn
I was reading a post just now and the symptoms sound similar to mine..
When I sit (ergo correct) after about 20 minutes I expereince just a bit
of numbness (lower back left side- buttocks area) within about 1 minute
I have a burning tingling in my left shoulder (very uncomfortable)which last for minimum 5 minutes max 15.
The only way to relieve is to slouch in chair or to roll more towards right side.
This occurs sometimes 10 to 15 times a day
I am a 49 F 5'5  160...  I did have herniated disk injury to my back however this
was 15 years ago......  thoughts?
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Avatar_f_tn
I had a spinal tap done because my eye specialist said my optic nerve was bruised thsmen they said my opening pressure was 320 since then I have extreme sensesitivity to light,pain behind.eyes, major fatigue and visual problems anyone can help me please
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