I have been having periodic severe headaches mainly behind my nose and sometimes my forehead and the top of my head. I've also had extreme pressure in the same areas and the back of my head. There have been several "bugs" cultured from my sinuses including Blastomyces, Serratia marcescens, and most recently Stenotrophomans maltophilia. I was on Sporanox for 2 months and then Bactrin for about a month, but the haeadaches have persisted. My ENT examination and CT scans appear normal, but I continue to have huge amounts of postnasal drip that is clear to whitish. It is so copious that it drains into my chest and I feel like I am going to suffocate. I have chills and periodic drenching night sweats, but no fever. When the drainage starts the headaches will let up, but I feel nauseus and lethargic at times and just want to sleep.
I am scheduled to have a lumbar puncture on the 16th for possible chronic meningitis. I'm a little scared to have this done and would like to rule out other things.
1. Does it sound resonable to have the lumbar puncture done?
(I did cough up brown sputum for several years before the diagnosis of blastomycosis.)
2. Is it possible that I have CSF rhinorrhea? The drainage is usually glue-like, but thin on occasion. Does it always come out the nose or can it be postnasal drip?
3. Should I continue to pursue the sinusitis angle and request another culture? (I did have chronic ethmoid sinusitis at one time and had surgery for it)
Without knowing your case, I cannot give a definite answer or clinical diagnosis
It does sound reasonable to do a lumbar puncture - some of those bugs once they 'move in' can be difficult to eradicate and can potentially involve the meninges (but not like an acute meningitis)
A lumbar puncture is a standard procedure, as familiar and simple as a blood draw to neurologists. It can even be done under xray guidance in circumstances where it may be more difficult like a lot of back arthritis or obesity.
CSF is clear and water like, although if infected can appear more opalescent. Some information can be obtained from the fluid ie measuring salt and glucose concentrations to determine where it is from (although limited). If your sinuses are infected however it is more likely that this is where the fluid is coming from.
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