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Suggest Treatment For Intracranial Hypotension
Question: I have been diagnosed w inter cranial hypotension And would like to know what I can do to improve it. I try to stay hydrated n walking helps
Brief Answer:
What happened to the diagnosis of NPH?
Detailed Answer:
Good morning. I am a neurologist and have read both your present question as well as a previous query you posed in Aug. 2015 stating that you'd been diagnosed with NPH.
Can you clarify if the diagnosis of NPH was actually confirmed by neurological evaluation as well as a lumbar puncture which was also suggested by Dr. Panwar? Otherwise, please tell me how the NEW DIAGNOSIS of INTRACRANIAL HYPOTENSION was discovered. These are 2 very different conditions and even from a radiographic perspective I'm not sure how one could've been confused with the other. Nonetheless, in order to directly answer your question if we assume that HYPOtension is your diagnosis intracranially then, what that implies is that there is not enough circulating volume of CSF. There is nothing really that one can do with the possible exception of drinking fluids though this is not truly something that we'd expect to make a huge difference to anything (unless you were ridiculously dehydrated and even in that circumstance circulating CSF volume tends to be preserved at the expense of other body compartments)....but it's a good thing to do no matter what, right?
What is more important is for the doctors to discover WHY you have HYPOtension since that may suggest the presence of a CSF leak that needs to be plugged and stopped. Therefore, a neurologist once again is your best bet to clinically diagnosing this condition if they are not already looking at you and suggesting a plan to possibly include a BLOOD PATCH to stop any leaks in the system.
I hope this addresses your concerns. If so, may I ask for the favor of a HIGH STAR RATING on our interaction and some brief written feedback.
Write to me at: bit.ly/drdariushsaghafi for additional comments, concerns, or to upload information that you would like me to look at in the event you may have reports for any imaging studies done of the head, labs performed, or doctor's notes you'd like reviewed.
This query required 17 minutes to read, research, and compile an envoy to the patient.
What happened to the diagnosis of NPH?
Detailed Answer:
Good morning. I am a neurologist and have read both your present question as well as a previous query you posed in Aug. 2015 stating that you'd been diagnosed with NPH.
Can you clarify if the diagnosis of NPH was actually confirmed by neurological evaluation as well as a lumbar puncture which was also suggested by Dr. Panwar? Otherwise, please tell me how the NEW DIAGNOSIS of INTRACRANIAL HYPOTENSION was discovered. These are 2 very different conditions and even from a radiographic perspective I'm not sure how one could've been confused with the other. Nonetheless, in order to directly answer your question if we assume that HYPOtension is your diagnosis intracranially then, what that implies is that there is not enough circulating volume of CSF. There is nothing really that one can do with the possible exception of drinking fluids though this is not truly something that we'd expect to make a huge difference to anything (unless you were ridiculously dehydrated and even in that circumstance circulating CSF volume tends to be preserved at the expense of other body compartments)....but it's a good thing to do no matter what, right?
What is more important is for the doctors to discover WHY you have HYPOtension since that may suggest the presence of a CSF leak that needs to be plugged and stopped. Therefore, a neurologist once again is your best bet to clinically diagnosing this condition if they are not already looking at you and suggesting a plan to possibly include a BLOOD PATCH to stop any leaks in the system.
I hope this addresses your concerns. If so, may I ask for the favor of a HIGH STAR RATING on our interaction and some brief written feedback.
Write to me at: bit.ly/drdariushsaghafi for additional comments, concerns, or to upload information that you would like me to look at in the event you may have reports for any imaging studies done of the head, labs performed, or doctor's notes you'd like reviewed.
This query required 17 minutes to read, research, and compile an envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
After cistern XXXXXXX which they only did the spinal tap to input fluid to check for leak which there were none the results were NPH. My neurologist did not think my symptoms matched this. The two MRIs before this test diagnosed intracranial hypotension. The last dr visit suggested taking neuron tin or doing another MRI. I take 0.5 clonazepam n RA Cetirzine 10 mg 1 hr before I retire and it knocks me out for about four hours so I am Leary of adding a new med that might further affect my balance as I am 68. Thank you for any advice or opinion you may have
Brief Answer:
What are your symptoms?
Detailed Answer:
Thusfar, I do not know what the symptoms are that you are dealing with? If a diagnosis of NPH were first thought to be the case then, usually the clinical symptoms associated with that first thought would be things such as cognitive dysfunction (i.e. forgetfulness, short term memory loss, mild form of dementia) plus urinary incontinence, and gait disturbance in the form of what is referred to as a MAGNETIC GAIT. That's not the same as a shuffling gait seen in Parkinson's gait but rather it's when patients PUSH their feet across the floor. They have a tough time LIFTING their feet to take steps and as a result can have frequent falls. They may or may not have trouble initiating their steps. To me, just in the way you're writing and thinking as well as just being able to successfully use a computer to answer and ask questions---I have a hard time believing that you suffer from any form of cognitive dysfunction or dementing illness. So that would be the diagnosis of NPH. Of course, if the radiologist saw ENLARGED ventricles with lots of space and saw your age they may have just assumed all the rest of it and said, "Yeah...that's probably NPH..." You can clarify if you want how the neurologist came up with that diagnosis.
But, then, if intracranial HYPOTENSION were next being thought of then, my guess is you're complaining of headaches and ones which can be particularly bad when standing but then, get much better when lying down. In fact, in many people the headaches will go completely away but then, when they stand or sit back up....headaches come back. That type of picture is generally seen in INTRACRANIAL HYPOTENSION due to CSF leaks. Now, for the MRI to suggest this it would necessary to show a cap or ring of CSF fluid surrounding the meningeal covering of the brain. In other words, if there is a leak of fluid which is supposed to be INSIDE of the brain and spinal cord coverings then, logically that fluid will escape to the outside. On specific sequences of MRI scans it is usually very easy to see the presence of CSF in a place that it's not supposed to be...OUTSIDE THE AREA OF THE BRAIN AND MOREOVER OUTSIDE THE BRAIN COVERINGS. It's almost like coming home from work and finding your kids on the roof of your house....ever have that happen? LOL!
However, if they then, did either a CT MYELOGRAM or a RADIOISOTOPE study to try and find the leak and did not see one then, that is why they are saying there is no leak. But again, a lot depends on your symptoms. Sometimes those types of studies can be misleading and wrong if they are read as negative especially if you continue to have classic symptoms of fluctuating headaches or migraine aura or any other neurological symptoms (vertigo, imbalance, symptoms of headache aura, etc.).
I'm a little concerned that they are giving you both clonazepam and Cetirzine to "knock" you out for 4 hrs. at nighttime as opposed to either doing appropriate workups to get to the root of your problem of insomnia or come up with a better solution than to use chronic benzodiazepines and antihistamines for their side effects...but since your question is not related to those aspect of things I won't comment any further. It sounds like the clonazepam and cetirizine are affecting your balance to some extent anyway in addition to the condition that you have of either intracranial hypotension, migraine headaches, or other problem so I understand why you may be reticent to try Topamax.
Without knowing exactly what your symptoms are or how they've changed over the past few days/weeks since having these procedures done. and without being able to actually LOOK at the MRI films or the reports to see what they're seeing it is hard for me to say whether or not Topamax is something that I would agree to recommending for you. On the one hand it is recognized as the most effective ANTIMIGRAINE medication when migraines are chronic and daily. However, if the headaches are intermittently coming on as I described and fluctuate depending on your posture and you can demonstrate this fact on a consistent basis by keeping a daily headache log...despite negative findings of the radioisotope scan and/or CT myelogram I might try sending my patient for a BLOOD PATCH and see if the headaches can resolve without placing them on any chronic medication if I were certain that the clinical symptoms point to leak and not something else that could be causing low volume in the CSF, such as dehydration, not enough CSF production, etc. etc. In other words, I would continue to work the patient up a bit more before settling on medications.
Write to me at: bit.ly/drdariushsaghafi for additional comments, concerns, or to upload information that you would like me to look at in the event you may have reports for any imaging studies done of the head, labs performed, or doctor's notes you'd like reviewed.
This query required a total of 77 minutes to read, research, and compile an envoy to the patient.
What are your symptoms?
Detailed Answer:
Thusfar, I do not know what the symptoms are that you are dealing with? If a diagnosis of NPH were first thought to be the case then, usually the clinical symptoms associated with that first thought would be things such as cognitive dysfunction (i.e. forgetfulness, short term memory loss, mild form of dementia) plus urinary incontinence, and gait disturbance in the form of what is referred to as a MAGNETIC GAIT. That's not the same as a shuffling gait seen in Parkinson's gait but rather it's when patients PUSH their feet across the floor. They have a tough time LIFTING their feet to take steps and as a result can have frequent falls. They may or may not have trouble initiating their steps. To me, just in the way you're writing and thinking as well as just being able to successfully use a computer to answer and ask questions---I have a hard time believing that you suffer from any form of cognitive dysfunction or dementing illness. So that would be the diagnosis of NPH. Of course, if the radiologist saw ENLARGED ventricles with lots of space and saw your age they may have just assumed all the rest of it and said, "Yeah...that's probably NPH..." You can clarify if you want how the neurologist came up with that diagnosis.
But, then, if intracranial HYPOTENSION were next being thought of then, my guess is you're complaining of headaches and ones which can be particularly bad when standing but then, get much better when lying down. In fact, in many people the headaches will go completely away but then, when they stand or sit back up....headaches come back. That type of picture is generally seen in INTRACRANIAL HYPOTENSION due to CSF leaks. Now, for the MRI to suggest this it would necessary to show a cap or ring of CSF fluid surrounding the meningeal covering of the brain. In other words, if there is a leak of fluid which is supposed to be INSIDE of the brain and spinal cord coverings then, logically that fluid will escape to the outside. On specific sequences of MRI scans it is usually very easy to see the presence of CSF in a place that it's not supposed to be...OUTSIDE THE AREA OF THE BRAIN AND MOREOVER OUTSIDE THE BRAIN COVERINGS. It's almost like coming home from work and finding your kids on the roof of your house....ever have that happen? LOL!
However, if they then, did either a CT MYELOGRAM or a RADIOISOTOPE study to try and find the leak and did not see one then, that is why they are saying there is no leak. But again, a lot depends on your symptoms. Sometimes those types of studies can be misleading and wrong if they are read as negative especially if you continue to have classic symptoms of fluctuating headaches or migraine aura or any other neurological symptoms (vertigo, imbalance, symptoms of headache aura, etc.).
I'm a little concerned that they are giving you both clonazepam and Cetirzine to "knock" you out for 4 hrs. at nighttime as opposed to either doing appropriate workups to get to the root of your problem of insomnia or come up with a better solution than to use chronic benzodiazepines and antihistamines for their side effects...but since your question is not related to those aspect of things I won't comment any further. It sounds like the clonazepam and cetirizine are affecting your balance to some extent anyway in addition to the condition that you have of either intracranial hypotension, migraine headaches, or other problem so I understand why you may be reticent to try Topamax.
Without knowing exactly what your symptoms are or how they've changed over the past few days/weeks since having these procedures done. and without being able to actually LOOK at the MRI films or the reports to see what they're seeing it is hard for me to say whether or not Topamax is something that I would agree to recommending for you. On the one hand it is recognized as the most effective ANTIMIGRAINE medication when migraines are chronic and daily. However, if the headaches are intermittently coming on as I described and fluctuate depending on your posture and you can demonstrate this fact on a consistent basis by keeping a daily headache log...despite negative findings of the radioisotope scan and/or CT myelogram I might try sending my patient for a BLOOD PATCH and see if the headaches can resolve without placing them on any chronic medication if I were certain that the clinical symptoms point to leak and not something else that could be causing low volume in the CSF, such as dehydration, not enough CSF production, etc. etc. In other words, I would continue to work the patient up a bit more before settling on medications.
Write to me at: bit.ly/drdariushsaghafi for additional comments, concerns, or to upload information that you would like me to look at in the event you may have reports for any imaging studies done of the head, labs performed, or doctor's notes you'd like reviewed.
This query required a total of 77 minutes to read, research, and compile an envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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