Re: spinal fluid leak

Posted By rick on March 25, 1999 at 21:43:33:

In Reply to: Re: spinal fluid leak posted by CCF Neuro[P] MD, RPS on March 25, 1999 at 18:23:47:






I have read your archives on spinal headaches, but have additional questions.  I got a spinal headache 3 months ago following a prolotherapy treatment.  After 3 days of severe headache, I received a blood patch, rested horizontal for about 15 minutes, and sent home.  I did not lay down after this.  The headache dissapeared completely for about 10 hours.  Then, a smaller headache returned which I have had since.  I have had 2 more blood patches since, and in each case, felt worse after.  I had a lumbar MRI after the second patch.  The report indicated no vissible leakage.  I feel it is still there, but very small.  In all of these blood patches, I was sent home lying down in our minivan.  The ride felt qiite bumpy in this position and even the braking/acceleration forces were felt.  Would this have destroyed any possible success of the patch?  Also, I wonder if at this point a blood patch may be ineffective with the greater fluid pressure, since the headache is much smaller.  Maybe the small hole acts like a nozzle now, blowing away the patch.  At this point, does extended bed rest really work?  If so, how long, can you move in bed, and can you get up to go to the bathroom and shower?  I also read in your archive about draining fluid 3-5 days with bed rest, is this the next step, it sounds risky.  I am willing to do nothing and let nature take its course, however, I have the feeling this condition may become chronic?  What are your comments about a surgical patch?  




Dear Rick:
Sorry to hear about all your problems with the blood patching.  We usually recommend that the patient remain flat/prone or best supine for several hours after the patch (12-15 hours).  Yes you can get up to go to the bathroom etc.  The blood patch is just some blood place around the leak, hoping the the coagulation factors in the blood will seal the leak.  The usual range of CSF pressure should not disrupt the patch.  The MRI suggests that the leak has healed (?).  I have seen 2 blood patches required but that is the most I have experience.  You can request a CSF flow study that may help define if there is a leak, but I am not sure how sensitive that would be with a real small leak.  If the patch did not work within a day, then likely it was not effective.  However, the headache may not be due to the leak.  Does the headache worsen when you sit up or stand up?  If it doesn't then the headache may be from another cause.  Drink plenty of fluid and try taking some ibuprofen and see if your symptoms are as I just described.  If they are then you likely still have a spinal tap leak.
Sincerely,
CCF Neuro[P] MD




The pain definately is positional tolerent.  I can tilt my head and feel the pressure move from side to side.  Laying down helps considerably.  Can you please answer these questions?
1)  Is a caffeine IV effective?
2)  Are you suggesting that a patient stay at the place the blood patch is performed for 12-15 hours, mostly laying down?
3)  Why would these patches have made the pain worse for at least a week?
4)  Does extended time in bed cure this, and must you not get up for any reason?
5)  Does it really work to reduce theCSF pressure with an IV, and then bed rest for 3-5 days?