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Neurology (Expert Forum)
csf leak?
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csf leak?
by bklk, Dec 28, 2004 12:00AM
Hello,
I posted twice prior and think I can ask some general questions that you can really point me in a proper direction.
I was DX’d with viral meningitis in Dec. with 23 wbc-89% lymphocytes and high protein.
Headaches remain severe with left arm and 5th cranial nerve pain that is also severe with activity.
I had MRA, 2MRI, all normal.
2 more LP’s showed 10 WBC-90lymphocytes protein 60, then clear on the third.
I finally had another LP to look for viral PCR, Sarcoidosis, etc. All normal.
The LP had 69RBC with 4WBC on tube 1
Then 2 WBC 2 RBC at tube 3.
The opening pressure was about 4-or5 (scale) 5-15.
But I was lying supine for fluoroscopy with two pillows under my abdomen so I assume I was in valsalva which would have elevated pressure.
The radiologist M.D had to raise the table to get flow of fluid.
Does this point to low pressure? A leak?
Could not the leak itself casuse the pleocytosis of 23WBC that was initially called viral meningitis?
How would a leak be found at CCF, I undertand they can be difficult to locate.
I had a blood patch 3 months ago that failed but I was not made to lie afterwords, and no location of leak was known it failed completely
Any other ideas I might be missing?
Thanks
I posted twice prior and think I can ask some general questions that you can really point me in a proper direction.
I was DX’d with viral meningitis in Dec. with 23 wbc-89% lymphocytes and high protein.
Headaches remain severe with left arm and 5th cranial nerve pain that is also severe with activity.
I had MRA, 2MRI, all normal.
2 more LP’s showed 10 WBC-90lymphocytes protein 60, then clear on the third.
I finally had another LP to look for viral PCR, Sarcoidosis, etc. All normal.
The LP had 69RBC with 4WBC on tube 1
Then 2 WBC 2 RBC at tube 3.
The opening pressure was about 4-or5 (scale) 5-15.
But I was lying supine for fluoroscopy with two pillows under my abdomen so I assume I was in valsalva which would have elevated pressure.
The radiologist M.D had to raise the table to get flow of fluid.
Does this point to low pressure? A leak?
Could not the leak itself casuse the pleocytosis of 23WBC that was initially called viral meningitis?
How would a leak be found at CCF, I undertand they can be difficult to locate.
I had a blood patch 3 months ago that failed but I was not made to lie afterwords, and no location of leak was known it failed completely
Any other ideas I might be missing?
Thanks
Doctor's Answer
by CCF-Neuro-M.D.-CS, Dec 29, 2004 12:00AM
It is difficult to interpret the pressure reading without understanding the needle position, and the table position at the time of the recording. If it truely is low, this could indicate the presence of a leak. The techniques utilized to detect a CSF leak vary depending on the location suspected. Modalities which can be used include MRI, CT scans (thin slice), CT scans with dye places into the CSF, and radionucleotide scans.
Patients with spontaneous leaks can have elevated WBC's, but this typically occurs after the leak has been present for a period of time. Also, the lympocyte predominance would not be typical. Again, it would be reasonable to have this condition re-evaluated at a large center. Good luck.
Patients with spontaneous leaks can have elevated WBC's, but this typically occurs after the leak has been present for a period of time. Also, the lympocyte predominance would not be typical. Again, it would be reasonable to have this condition re-evaluated at a large center. Good luck.
The mri DID catch a "small arachnoid cyst in the quadrigeminal cistern plate."
EVERYONE dismsisses this completely, but could a cyst in this area expand and contract with activity and create symptoms.
I searched extensively and see a large body of the literature that shows the high incidence of incidental cysts as well as a few case studies and anecdotal reports of "small" arachnoids, dermoids, etc, that DO create symptoms and DID respond to surgery.
How can a patient (or should they) get a evaluation as to the probability the cyst, this cyst is a few mm's so it is small is an issue?
I'm disabled by whatever is causing these headaches and so far they have been called post-viral, migranine, etc, and as the patient I can know this is wrong!
The headaches are FAR too constant and far too bad.
Thanks
Brian