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Neurology (Expert Forum)
help?
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
help?
by bklk, Nov 27, 2004 12:00AM
Asked once prior about my “meningitis.” Severe headaches following a vial sore throat.
39yr male with otherwise excellent health prior surgery for disc implant.
I as dx’ed sept 1st with lumbar puncture of 23wbc-89%lymphs. 60 protein
2nd done 10-10 showed 3WBC and protein 60
again 11-1 all clear.
2 MRI normal, 3rd w/c showed small quadrigeminal cistern cyst.
MRA normal
Recurrent left maxillary sinusitis on scans treated with surgery-no help.
Medrol doespack failed
High prednisone failed.
I will come to CCF in Dec. but want to ask some things,
I see CCF, Mayo, etc, try to wean all meds which I am doing, do you see rebound headaches that are actually severe in nature or is this unusual, I’ve been on opiates for back surgery then used them for the Headaches 5 or more days for 3+months. I also have facial tingling and left arm paresthesia? Are such things seen with rebound?
Could the cyst be responsible? Everyone discounts it? Are there flow tests or ways to DX?
What about a csf leak either from the repeat LPs or spontaneous in the area of the maxillary sinus? I had a blood patch in lumbar but it did not help but searching archives here I see they sometimes need several tries? How is that tested for?
How likely is it the LP in Sept was coincidental? If you LP someone with a viral sore throat would you likely see small pleocytosis? Barking up the wrong tree with the meningitis? Any other ideas? I’m in deep do if I don’t get to some level of function soon.
Respectfully,
Doctor's Answer
by CCF-Neuro-M.D.-CS, Nov 30, 2004 12:00AM
Your case is very complex, and without sitting down and reviewing your history in detail and examining you it would be difficult to speculate as to the cause of your headaches. Yes, rebound headaches can be severe. The sensory changes would not be typical for rebound, but can be seen if a migraine is triggered.
Regarding a CSF leak, it is true that at times blood patches can fail. A typical CSF headache is better when lying down and becomes more severe with sitting or standing. This is typically diagnosed clinically, but some nuclear medicine tests can be used if a specific area for the leak is suspected.
The spinal tap was abnormal indicating some involvement of the central nervous system, and the term meningitis can be used.
Good luck with your visit.
Regarding a CSF leak, it is true that at times blood patches can fail. A typical CSF headache is better when lying down and becomes more severe with sitting or standing. This is typically diagnosed clinically, but some nuclear medicine tests can be used if a specific area for the leak is suspected.
The spinal tap was abnormal indicating some involvement of the central nervous system, and the term meningitis can be used.
Good luck with your visit.
