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Suggest Treatment For Post Lumbar Puncture Headache

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Posted on Wed, 21 May 2014
Question: I have a history of Irritable Bowel Syndrome, Innappropriate Sinus Tachycardia with PAC's and PVC's.
In December 2013 I gave birth to a little girl. I was given an epidural for pain which hurt extremely bad when it was given (an experience unlike my first born), about five minutes later I gave birth to my daughter. I was given a flu shot in the hospital also. Shortly after having her, I began to experience uneasy wozzy like spells. The doctors weren't concerned and I was sent home two days later. The third day home, I was admitted back into the hospital for sinus tachycardia. I have been dealing with these issues for several years. I had an elevated d-dimer and CT scan of chest with contrast to rule out blood clot. I was admitted for two days and during my stay I had developed hives, neck pain, the worst headache of my life (which I contribute to becoming tense during the CT scan and had the pain immediately after they laid me down flat to do the test). I was sent home and told it was my hormones that causes such spikes in my heart rate and I was told to continue my Inderal 10 mg twice a day. The headache continued non stop for two months. During those two months I began to experience motion sickness, disequilibrium, nausea like spells. I saw an ENT and he administered a VNG test. The results showed horizontal nystagmus related to the central nervous system. He was concerned that maybe something happened during my epidural and told me that this needed further evaluation because he does not see this often. Maybe a handful of times in over 20 years. I was sent for an MRI. It was in an open machine without contrast and came back normal. I have had back pain, neck pain, (its muscular) open MRI w/o contrast of spine were normal other than one bulging disc in L4. I saw a balance specialist and he did a whole bunch of tests all of which were normal that day. I was given zoloft and told I was just anxious. I was referred back to my neurologist and he suggested PT for the neck and back pain and also vestibular therapy none of which are helping. The person administering therapy for a month now believes there is something strange going on with my body and does not agree with the diagnosis of fibromyalgia and anxiety. The therapist told me, "You clearly have some sort of problem that is deeper than what has been found, I don't believe you are anxious, depressed, I can see that you are just frustrated because you want to enjoy your little one." I guess I should also mention I am not a first time mom. This is my second, my oldest being 10. I've had lab work which showed low Vit D and Vit B12. I've been taking supplements of those for close to two months. I also have IBS and have had more diarrhea lately, first episode an hour after giving birth and it has not let up since. I have had a few instances where I broke out in hives since the hospital admission back in Decemeber. Both were a few weeks ago and a few days apart. It seems like I have periods of time where I experience the vertigo, motion sickness, disequilibrium symptoms and the back/neck pain isn't as severe. When the back/neck pain is more severe I suffer less from the vertigo, motion sickness, disequilibrium, nausea symptoms. For instance two weeks ago I suffered horribly from these spells and nausea for a week straight. I felt like I was intoxicated and was constantly nauseated. I would attend therapy and then come home and rest. Even when I try to fall asleep I experience symptoms of the bed moving. During this time my neck and back pain weren't as severe. Fast forward to this past Friday. The spells subsided and I began to have extreme inflammation in my neck and back muscles along with pain. Sometimes it feels as if I have sun burn and I lost range of motion due to such tense muscles, deep in the cervical spine and on sides/back of neck. Yesterday, I had to take my oldest daughter to see a specialist, I got on an elevator and when I got off I suffered horribly for about 10 minutes with the spells I've been experiencing. I came home and the neck/back pain isn't as severe again, but the spells are back. My neurologist says that structurally everything looks good, but the anti-inflammatories and muscle relaxers prescribed he said should be helping along with the PT and it is not. I saw an optometrist and my eye exam was fine, he said my optic nerve looks healthy and he can get me to 20/20 vision with my glasses. Could my symptoms need further evaluation. I've also experienced some other quirky symptoms since this all began. I just don't understand how Dec 6 2013 I was fine and days later broken to the extent of where my family doctor has me off work because I don't know when the spells I am experiencing will hit.

Symptoms experience in the past four months:
brain fog, difficulty finding words, words coming out wrong, irritability, can't pay attention or concentrate on anything, tingling in extremities, muscle twitches/spasms as I am trying to sleep, nausea, vertigo, disequilibrium, motion sickness, back/neck pain, pain at epidural site, burning/hot feeling where the back and neck pain are, hip pain, diarrhea, hair loss (though may be due to postpartum?), I've had a metallic taste in my mouth a few times, unintentional weight loss (I started out March 2013 185 lbs and currently weigh 166 lbs.) I lost weight my entire pregnancy and continue to do so, very tired, headaches, cold feet/hands, racing heart, difficulty swallowing, changes in body odor, loss of libido.

I need someone to think outside of the box and help me figure this out so I can enjoy my little one and get back to work.
doctor
Answered by Dr. omz (46 hours later)
Brief Answer:
You are clearly a case of Post LP headache

Detailed Answer:
Hello

I am Dr.Omer and i am here to help you with your query.

I have read your query in detail and your diagnosis is clear cut that is POST LUMBAR PUNCTURE HEADACHE.

Brain and spinal cord are kept in fluid known as cerebrospinal fluid so that it does not hit the bones covering it.When ever epidural anaesthesia is given , we make a hole in your outer covering of spinal cord and then inject it.That hole in your spinal cord covering never healed since december 2013 and today is april.

Post LP headache usually starts 24-48 hrs after epidural injection as the spinal fluid starts to leak from this hole.

Whenever you go up or down in elevator, leakage of spinal fluid starts from this hole.Same thing happens when you stand up suddenly or sleep in a specific posture causes leakage of that fluid and your symptoms set in.

The usualy symptoms of Post LP headache are:

Severe intermittent vertigo , dizziness , sleepy head , tiredness , nausea , vomiting , diplopia , stars and lines when you see bright things , dysphagia , severe pain in back of the head , neack muscle / back , feeling to fall sudddenly.

Relief from this disease occurs in specific posture during sleep only.

Post LP headache is common in young females especially who have dysautonomia syndromes like IBS , POTS , tachycardia syndromes. ( that you have )

CT scan and MRI brain are usually normal in Post LP headache.

This disease stays for 2 months - 8 years from initial lumbar puncture done.

Treatment is simple , we have to cement your hole where the anaesthetist injected you with your blood known as blood patch of 30 ml and all your symptoms will go away in few days.

Hope this helps , feel free to ask any further queries.

I am amazed that your neurophyscian couldnt diagnose that because Post LP headache is a clinical diagnosis no specific test exists for this disease , you can also search this disease on google.

Take care
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. omz (23 hours later)
Thank tou so much for your advice. I am scheduling an appointment wih a new neurologist this week and bringing this to their attention. It really upests me because this is what i had initially thought was wrong and i was just brushed off as postpartum depression. Who would need to repair the leak a neurosurgeon?? I spoke directly to the anesthesiologist who administered the epidural about a month postpartum and he didnt feel i needed a blood patch because it was a month later and i had even went into the er and they called that department and didnt feel it was necessary because the odds are one in a million of needing a repair that far postpartum. I dont want to go back to that hospital again so what type of docto do i need to search for??r
doctor
Answered by Dr. omz (9 hours later)
Brief Answer:
Neurologist prescription is required !!!

Detailed Answer:
Thankyou for understanding.

Blood patch is a procedure done by aneathetist on request of neurologist only. An anaesthetist wont do it on its own, he needs confirmation from neurologist. Here blood is taken from your vein 30 ml and injected the same way he did the epidural injection.Total time taken for this procedure is 15 minutes , no anaesthesia required. Your blood when injected will close the hole.

Post LP headache is a common complication of epidural anaethesia , its not rare.

Hope this explains your query , don't forget to write a review if you are satisfied by my answers.

Take care
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. omz (13 hours later)
Could the complications from epidural cause the results i have attached??? The ent i saw felt like i was having complications from the epidural also but it wasnt something he knows about
doctor
Answered by Dr. omz (25 hours later)
Brief Answer:
99 % confirmation, you have Post LP headache

Detailed Answer:
Hello again XXXXXXX

I have seen the test done by ENT specialist which shows spontaneous nystagmus , saccade testing and broken pursuit test leads to disease of CEREBELLUM in your brain ( cerebellum is the last part of the brain from where spinal cord starts).

In your case the differentials of cerebellum disease are:(in order of decreasing priority)

1. Post LP headache , as i have said earlier that 99% chance is that you have this disease and the treatment is simple.In Post Lp headache due to low pressure cerebellum sinks down and you have that test results as attached to your query.

2. First attack of Multiple sclerosis , presents with the same symptoms as you have described , MRI with contrast is the investigation of choice not the simple MRI of brain.Multiple sclerosis is hidden during pregnancy and usually aggravates as soon as the delivery is done. I would suggest a VEP ( visually evoked potential ) test just to be on the same side with mri ( contrast ) of brain.But multiple sclerosis is very low in my differentials.I want to play safe with you as you are young and you have beautiful babies.

Still after seeing the test report my diagnosis of Post LP headache becomes more stronger ( with difficulty in swallowing and your other symptoms) but i want to examine you to rule out multiple sclerosis and other cerebellar diseases.

Kindly discuss all this with a expert neurologist , as he can see you and examine you.

Blood patch wont harm you and it is a simple treatment.

I tried my level best to diagnose you, without seeing or examining you.Hopefully an expert neurologist will diagnose you as i did.

Feel free to ask any further queries , wishing you health and happy family.

Take care XXXXXXX


Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. omz (2 days later)
I saw a neurologist today and apparently i come off as a deprrssed person and was told that i just need to sleep better and exercise. I was also told that i would have had a headache immediately after the epidural not two days later. I know i have a post lmbar pumcture leak. My headache is relieved when laying down and miserable while standing. What can i do to find a doctor who wont write me off as depressed? Im frustrated. u
doctor
Answered by Dr. omz (3 hours later)
Brief Answer:
Tell Your Symptoms Not Disease Details

Detailed Answer:
Hello Again,

Happy to know that you went to a neurologist , told your DISEASE and not your symptoms , which shows indirectly that you have done alot of internet research and he/she could not listen to you completely , to make the right diagnosis.

A female of 30s doing detailed rather direct doctor to patient discussion about her symptoms cannot be depressed. She needs to know whats wrong with her , doent not show depression rather it shows the interest she takes in her life for her babies as-well as for herself , so NO to depression from my point of view.

I have tried to tell you about your disease in a logical way with a counter check.Thanks for understanding me.

What you need to do is:
1. Tell your doctor your symptoms not the disease details what you have learnt from internet.

2. Find a neurologist who is not busy, not famous , but practicises in an honourable hospital institute like Allegheny general and so on.AND JUST SHOW HER YOUR ENT SPECIALIST EYE MOVEMENT TEST , BECAUSE TEST DONT LIE AND THEY ARE THE BIGGEST PROOF YOU ARE NOT DEPRESSED.

3. If noting happens Post LP headache goes away or decrease to a bearable amount by 8-12 months.

4. Or Just come to Pakistan , Lahore and after examining you ill do the blood patch free of cost.

Praying that you get your treatment with right diagnosis and get on with your life because its a long way as you have 2 babies.Just pre-cauationary do-not do alot of jogging , swimming , jumping as that can competely pull cerebellum down-wards and it is a bad thing.

Take care

Take care


Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. omz (24 hours later)
Okay, i will take your advice and keep trying. My mom is a nurse and she is greatly upset at how little progress i have made since this all started last december. She scheduled me to see a neuro-opthamologist 3 hours out of town in Hershey, Pennsylvania next week. Not sure if i will make any progress there or not. Is there any way to add you as a favorite doctor? Id like to keep in touch and let you know if i make any progress. Especially if i have more questions, i would prefer to speak with someone who is familiar with my situation. You have been so helpful and hasve given me hope that at some point i will improve. You have great patience and i wish you were here in the US!!! If i could afford to i would come to pakistan. My first daughter is part lebanese, but i dont believe her aunt is going back to visit family in Lebanon until christmas time or i would fly out with her and stay with the. Lol! m
doctor
Answered by Dr. omz (47 hours later)
Brief Answer:
OBLIGED!

Detailed Answer:
Hello again,

Thankyou for understanding.You have been very helpful too, by giving a good detail history of your problem.Yes you can contact me again by sending my a direct question to my name( by searching it ).Go to services>ask a specialist>select internal medicine specialist > then my name will be visible.I will get your query in no time through mobile short message , email and i will be happy to answer you.

You are welcome to Pakistan any time.

Wishing you health, Take care.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. omz (2 days later)
Do you think acupuncture would be beneficial at all??
doctor
Answered by Dr. omz (19 hours later)
Brief Answer:
Acupuncture efficacy is Doubtful.

Detailed Answer:
Hello Again

Acupuncture appears to be effective in many patients.It depends on the practioner experience and the patient views about acupuncture.Actually its a chinese method of treating headache and backaches.I would recommend to try it.Maybe it will give you complete relief from pain and vertigo.

Hope this helps.
Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. omz

Internal Medicine Specialist

Practicing since :2005

Answered : 508 Questions

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Suggest Treatment For Post Lumbar Puncture Headache

Brief Answer: You are clearly a case of Post LP headache Detailed Answer: Hello I am Dr.Omer and i am here to help you with your query. I have read your query in detail and your diagnosis is clear cut that is POST LUMBAR PUNCTURE HEADACHE. Brain and spinal cord are kept in fluid known as cerebrospinal fluid so that it does not hit the bones covering it.When ever epidural anaesthesia is given , we make a hole in your outer covering of spinal cord and then inject it.That hole in your spinal cord covering never healed since december 2013 and today is april. Post LP headache usually starts 24-48 hrs after epidural injection as the spinal fluid starts to leak from this hole. Whenever you go up or down in elevator, leakage of spinal fluid starts from this hole.Same thing happens when you stand up suddenly or sleep in a specific posture causes leakage of that fluid and your symptoms set in. The usualy symptoms of Post LP headache are: Severe intermittent vertigo , dizziness , sleepy head , tiredness , nausea , vomiting , diplopia , stars and lines when you see bright things , dysphagia , severe pain in back of the head , neack muscle / back , feeling to fall sudddenly. Relief from this disease occurs in specific posture during sleep only. Post LP headache is common in young females especially who have dysautonomia syndromes like IBS , POTS , tachycardia syndromes. ( that you have ) CT scan and MRI brain are usually normal in Post LP headache. This disease stays for 2 months - 8 years from initial lumbar puncture done. Treatment is simple , we have to cement your hole where the anaesthetist injected you with your blood known as blood patch of 30 ml and all your symptoms will go away in few days. Hope this helps , feel free to ask any further queries. I am amazed that your neurophyscian couldnt diagnose that because Post LP headache is a clinical diagnosis no specific test exists for this disease , you can also search this disease on google. Take care