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What Do Headaches, Nausea, Pulsatile Tinnitus And Shoulder Pain Indicate?
Question: I had Chiari malformation surgery in 2004. Since then I have progressively started having the same symptoms I have had before. In doing some research I found that my symptoms coincide with Idiopathic intracranial pressure. I have headaches, nausea, some vision problems, pulsatile tinnitus, stiff neck, back and shoulder pain. My MRI is normal with the exception of an empty sella turcica. Am I on the right track with this?
Brief Answer:
You are on the right track.
Detailed Answer:
Thank you for posting your query.
I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.
I have noted your clinical details. Based on this, I agree with you that the most likely diagnosis seems to be idiopathic intracranial hypertension (IIH), causing raised intracranial pressure (ICP).
Diamox is the correct medicine for IIH. In some cases, oral prednisolone (steroid) may be needed, if the ophthalmologist sees inadequate response to diamox.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
You are on the right track.
Detailed Answer:
Thank you for posting your query.
I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.
I have noted your clinical details. Based on this, I agree with you that the most likely diagnosis seems to be idiopathic intracranial hypertension (IIH), causing raised intracranial pressure (ICP).
Diamox is the correct medicine for IIH. In some cases, oral prednisolone (steroid) may be needed, if the ophthalmologist sees inadequate response to diamox.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
MRI, eye examination and lumbar puncture are needed for confirmation.
Detailed Answer:
Thank you for getting back.
I can understand your situation, when the neurologist is not willing to accept that it is IIH, and insists that the symptoms are due to migraines.
For diagnosis of IIH, three steps are needed:
1. MRI brain,
2. Eye examination- Fundus examination of eye shows papilledema (swollen optic nerve discs). This can be done by your ophthalmologist.
3. Lumbar puncture- This can show the exact CSF pressure, confirming the diagnosis of raised ICP.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
MRI, eye examination and lumbar puncture are needed for confirmation.
Detailed Answer:
Thank you for getting back.
I can understand your situation, when the neurologist is not willing to accept that it is IIH, and insists that the symptoms are due to migraines.
For diagnosis of IIH, three steps are needed:
1. MRI brain,
2. Eye examination- Fundus examination of eye shows papilledema (swollen optic nerve discs). This can be done by your ophthalmologist.
3. Lumbar puncture- This can show the exact CSF pressure, confirming the diagnosis of raised ICP.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have had an MRI which shows an empty sella. The eye exam shows that I had ICP but not papilledema. I have never gotten a lumber puncture. The doc sees the Neuro doc sees the MRI and goes no further.
Brief Answer:
You need to get lumbar puncture done.
Detailed Answer:
Thank you for getting back with more information.
You need to discuss with your neurologist that IIH causing raised ICP is a distinct possibility and it needs to be excluded. This needs lumbar puncture. If he does not listen, you probably need to see another neurologist.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
You need to get lumbar puncture done.
Detailed Answer:
Thank you for getting back with more information.
You need to discuss with your neurologist that IIH causing raised ICP is a distinct possibility and it needs to be excluded. This needs lumbar puncture. If he does not listen, you probably need to see another neurologist.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. Too bad you don't live here in XXXXXXX Al. I will be looking for another neurologist. Should I see a neurologist or neurosurgeon for this?
Brief Answer:
You should see a neurologist.
Detailed Answer:
Thank you for getting back.
You should see a neurologist for diagnosis and treatment of IIH.
Only a small proportion of patients do not adequately respond to medical treatment (oral steroids and diamox), and they need to see a neurosurgeon for theco-peritoneal (or lumbo-peritoneal) shunt surgery.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
You should see a neurologist.
Detailed Answer:
Thank you for getting back.
You should see a neurologist for diagnosis and treatment of IIH.
Only a small proportion of patients do not adequately respond to medical treatment (oral steroids and diamox), and they need to see a neurosurgeon for theco-peritoneal (or lumbo-peritoneal) shunt surgery.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. I really appreciate your advice.
Brief Answer:
Thank you.
Detailed Answer:
My best wishes to you,
Dr Sudhir Kumar MD DM (Neurology)
Thank you.
Detailed Answer:
My best wishes to you,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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