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What Is The Normal Adult CSF Pressure Range?
Question: What is the range in mm mercury of normal adult csf pressure
Brief Answer:
Normal adult CSF pressure is 7-15 mm of mercury.
Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
Yes,I am afraid to say that your CSF pressure was too high. Normal adult CSF pressure ranges from 7 to 15 mm hg (mercury).
Elevated CSF pressure can be found in some patients of spontaneous CSF leaks.The pathogenesis or unknown cause for this is not known.
Your treating doctor was probably right in prescribing you Diamox so as to lower the CSF pressure as very high pressure even can interfere with success of epidural patch.
One point I would like to make is that please keep taking Diamox and be on monitoring for CSF pressure.
Please meet a clinical neurologist and get evaluated for primary causes of elevated CSF pressure(if there is some other reason for the elevated CSF pressure,that we can treat),not assuming here that it is associated with spontaneous CSF leak only.MRI can be normal with raised CSF pressure in Idiopathic intracranial hypertension(IIH).
Hope I have answered your query for now.If you have some follow up queries,I shall be glad to answer else,please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Normal adult CSF pressure is 7-15 mm of mercury.
Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
Yes,I am afraid to say that your CSF pressure was too high. Normal adult CSF pressure ranges from 7 to 15 mm hg (mercury).
Elevated CSF pressure can be found in some patients of spontaneous CSF leaks.The pathogenesis or unknown cause for this is not known.
Your treating doctor was probably right in prescribing you Diamox so as to lower the CSF pressure as very high pressure even can interfere with success of epidural patch.
One point I would like to make is that please keep taking Diamox and be on monitoring for CSF pressure.
Please meet a clinical neurologist and get evaluated for primary causes of elevated CSF pressure(if there is some other reason for the elevated CSF pressure,that we can treat),not assuming here that it is associated with spontaneous CSF leak only.MRI can be normal with raised CSF pressure in Idiopathic intracranial hypertension(IIH).
Hope I have answered your query for now.If you have some follow up queries,I shall be glad to answer else,please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Shanthi.E
I think the only way to assess csf pressure is by lumbar puncture. My vision has been basically ok but occasionally when I am looking at a page I see a lot of yellow background or green background on the page but only at certain angles. I got checked by an optometrist about 3 months ago but this was before the onset of this symptom. I get mild headaches or I mght say I am "headachy" especially in the evening. I will talk to my neurologist but he does not know a heck of a lot about this stuff. Does this sound concerning? I will try to seek another opinion but my case is so unusual no one in Toronto seems to be on top of it.
1- I need another lumbar puncture to see what changes if any are needed in Diamox dose. Do you agree?
2- Are my subtle visual symptoms which are usually not present when I read signifigant?
Thank you for previous correspondence- have you seen people like me? My first problems started 4 yrs ago and still not feeling great. I have gone from not being able to walk more than 3oo yds to back to stressful job, walking 6 miles, golfing etc. I am not depressed just wish I could feel better.
Thank you. XXXX
1- I need another lumbar puncture to see what changes if any are needed in Diamox dose. Do you agree?
2- Are my subtle visual symptoms which are usually not present when I read signifigant?
Thank you for previous correspondence- have you seen people like me? My first problems started 4 yrs ago and still not feeling great. I have gone from not being able to walk more than 3oo yds to back to stressful job, walking 6 miles, golfing etc. I am not depressed just wish I could feel better.
Thank you. XXXX
Brief Answer:
Diamox dose to be monitored with symptoms,not with Lumbar puncture.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing your medical history with better details.
I can really understand your concerns.You don't need to get frequent(not less than one in 6 months) Lumbar punctures done to monitor CSF pressure.Instead,it should be clinical monitoring.Diamox dosing should be correlated with your symptoms improvement or worsening as we are not treating any MRI or CSF,but we are treating a patient.
Please visit an ophthalmologist and get a funduscopic examination done to see whether you have papilledema.Although,your visual symptoms don't appear to be that significant.
PLease answer two questions:
Do you have history of transient visual obscurations?
Is your headache more in standing position or lying supine position?
Yes,I have seen a couple of patients like you and saw them improving clinically with treatment.Please don't get depressed and maintain your motivation levels as motivation is the key to success.
Meanwhile,continue diamox and go ahead with the fibrin glue patch.That is the appropriate management for you now.
Please tell details and be in follow-up.
Dr.Ajay Panwar,
MD,DM(Neurology)
Diamox dose to be monitored with symptoms,not with Lumbar puncture.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing your medical history with better details.
I can really understand your concerns.You don't need to get frequent(not less than one in 6 months) Lumbar punctures done to monitor CSF pressure.Instead,it should be clinical monitoring.Diamox dosing should be correlated with your symptoms improvement or worsening as we are not treating any MRI or CSF,but we are treating a patient.
Please visit an ophthalmologist and get a funduscopic examination done to see whether you have papilledema.Although,your visual symptoms don't appear to be that significant.
PLease answer two questions:
Do you have history of transient visual obscurations?
Is your headache more in standing position or lying supine position?
Yes,I have seen a couple of patients like you and saw them improving clinically with treatment.Please don't get depressed and maintain your motivation levels as motivation is the key to success.
Meanwhile,continue diamox and go ahead with the fibrin glue patch.That is the appropriate management for you now.
Please tell details and be in follow-up.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Dr. Panwar
Thank you again for timely and sound advice. No I have no obscurations in my vision and my headaches which I repeat are nowhere near as bad as they were when my csf pressure was low are not particularly postural and certainly not as they once were, where I could not stand up for 2 minutes.
I am quite interested in your advice to go ahead with a fibrin glue patch-
1- If my csf pressure is high would not the patch make it higher?
2- A definitive leak was never found and I have had digital-subtraction ct myelograms,regular myelograms with galodinium,mri spine. I do have diverticulae at t10 where my 4th patch which helped the most by far was put. As I live in Canada going to the USA for fibrin glue patch is a big deal as they
don't do it here. As a matter of fact I saw Dr. W Schievink (the guru) in LA for purpose of getting the patch oct 2014 and it was his guy who did a csf manometric reading before the patch,saw the pressure was up and cancelled the procedure. Dr. Schievink prescribed the Diamox, made no arrangements for follow-up and after wishing me luck murmured that maybe I should get the patch but did not explain himself and sort of hustled me out the door.
Again why the patch when my pressure is too high? It sounds counter-intuitive but I've learned in my case nothing goes according to plan.
As you my have guessed I am an MD (family) who is 65 y.o. just now retired. I did go from bedridden for 6 months (HEADACHES) without taking any codeine never mind narcotics (I was scared to become an addict and actually get better and have a big monkey on my shoulders) to working my crazy pace for the past three years. I retired 2 months ago to take it easy and have some R&R. I know quite a bit about my condition and am happy to find a doctor who knows about this thing. I know that usually things get better fairly quickly but not me.
As it is a neurological thing I have a myriad of symptoms including fatigue which is not me at all, burning parasthesias of arms legs and hands, a strange noise in my head that is not confined to an ear,rather an electrical current kind of sound,something like you might hear from high wires on a summer night or almost the buzz that your computer makes whenyou turn it on. This is with me most of the time and seems to have come on in the past year so it probably is due to elevated csf pressure. Lots of GI stuff. Biggest problem is an almost constant feeling of being drained- not really fatigued more like a vampire just had at me.
BUT- so much better than before patch #4! I owe any of my life for the past three years to Dr. XXXXXXX Peng an aneasthetist here in Toronto. Great guy knows a lot about csf leaks but increased pressure not that much.
Sorry to go on and on.
Very interested to hear your thoughts on fibrin patch Rx for me.
Thank you again. XXXX
Thank you again for timely and sound advice. No I have no obscurations in my vision and my headaches which I repeat are nowhere near as bad as they were when my csf pressure was low are not particularly postural and certainly not as they once were, where I could not stand up for 2 minutes.
I am quite interested in your advice to go ahead with a fibrin glue patch-
1- If my csf pressure is high would not the patch make it higher?
2- A definitive leak was never found and I have had digital-subtraction ct myelograms,regular myelograms with galodinium,mri spine. I do have diverticulae at t10 where my 4th patch which helped the most by far was put. As I live in Canada going to the USA for fibrin glue patch is a big deal as they
don't do it here. As a matter of fact I saw Dr. W Schievink (the guru) in LA for purpose of getting the patch oct 2014 and it was his guy who did a csf manometric reading before the patch,saw the pressure was up and cancelled the procedure. Dr. Schievink prescribed the Diamox, made no arrangements for follow-up and after wishing me luck murmured that maybe I should get the patch but did not explain himself and sort of hustled me out the door.
Again why the patch when my pressure is too high? It sounds counter-intuitive but I've learned in my case nothing goes according to plan.
As you my have guessed I am an MD (family) who is 65 y.o. just now retired. I did go from bedridden for 6 months (HEADACHES) without taking any codeine never mind narcotics (I was scared to become an addict and actually get better and have a big monkey on my shoulders) to working my crazy pace for the past three years. I retired 2 months ago to take it easy and have some R&R. I know quite a bit about my condition and am happy to find a doctor who knows about this thing. I know that usually things get better fairly quickly but not me.
As it is a neurological thing I have a myriad of symptoms including fatigue which is not me at all, burning parasthesias of arms legs and hands, a strange noise in my head that is not confined to an ear,rather an electrical current kind of sound,something like you might hear from high wires on a summer night or almost the buzz that your computer makes whenyou turn it on. This is with me most of the time and seems to have come on in the past year so it probably is due to elevated csf pressure. Lots of GI stuff. Biggest problem is an almost constant feeling of being drained- not really fatigued more like a vampire just had at me.
BUT- so much better than before patch #4! I owe any of my life for the past three years to Dr. XXXXXXX Peng an aneasthetist here in Toronto. Great guy knows a lot about csf leaks but increased pressure not that much.
Sorry to go on and on.
Very interested to hear your thoughts on fibrin patch Rx for me.
Thank you again. XXXX
Brief Answer:
You should not immediately go for patch.Wait for csf pressure to lower down
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and entrusting me while providing details.
I have gone through your further clinical details and suggest following answers to your queries-
1)A patch should not make CSF pressure higher because it is not leaks that are keeping pressure to normal in other individuals physiologically.Rather,it is not the right time to undergo a patch as too high a pressure might sometimes lead to patch failure.
Please keep taking Diamox and observe your symptoms.I hope the things will get better.In another 6 months,CSF pressure can be measured.If it comes towards normal,at that time depending on the symptoms,it can be decided whether the patch should be put or not(If CSF leak is there,it should be put definitely).
2)I am interested to know that how was the diagnosis of CSF leak confirmed or was it a strong suspicion only.(You said that none of the investigations was positive for it).Please upload MRI report/images/CD(CD can be uploaded on Google drive and link shared here).I am interested to see whether there are any indirect evidences in MRI for spontaneous CSF leak.Have you undergone nuclear cisternography,(which is probably the best investigation to detect a leak)?
3)Patch is not for high pressure.It is for blocking the CSF leak.Sometimes CSF leaks can be associated with high pressures,for pathogenesis unknown.
4)Please visit an ophthalmologist for funduscopic examination.
Please upload MRI images/CD(preferably) as I can see all source images on CD.Waiting for your follow-up.
Dr.Ajay Panwar,
MD,DM(Neurology)
You should not immediately go for patch.Wait for csf pressure to lower down
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and entrusting me while providing details.
I have gone through your further clinical details and suggest following answers to your queries-
1)A patch should not make CSF pressure higher because it is not leaks that are keeping pressure to normal in other individuals physiologically.Rather,it is not the right time to undergo a patch as too high a pressure might sometimes lead to patch failure.
Please keep taking Diamox and observe your symptoms.I hope the things will get better.In another 6 months,CSF pressure can be measured.If it comes towards normal,at that time depending on the symptoms,it can be decided whether the patch should be put or not(If CSF leak is there,it should be put definitely).
2)I am interested to know that how was the diagnosis of CSF leak confirmed or was it a strong suspicion only.(You said that none of the investigations was positive for it).Please upload MRI report/images/CD(CD can be uploaded on Google drive and link shared here).I am interested to see whether there are any indirect evidences in MRI for spontaneous CSF leak.Have you undergone nuclear cisternography,(which is probably the best investigation to detect a leak)?
3)Patch is not for high pressure.It is for blocking the CSF leak.Sometimes CSF leaks can be associated with high pressures,for pathogenesis unknown.
4)Please visit an ophthalmologist for funduscopic examination.
Please upload MRI images/CD(preferably) as I can see all source images on CD.Waiting for your follow-up.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Dr.Panwar
Again thank you for your reply. I think there are a few misunderstandings here. I think I told you that my investigations for source of csf leak were negative. However the diagnosis was not in doubt. I do not know how to transfer cd material but I will give you the highlites of mri May 24 2011- I first had a ct scan about 5 wks previous that showed bilat sliver thin subdural ?hygromas ?hematomas? I was Rx'd for that conservatively and continued to get massive orthostatic headaches. I knew what I had but could not convince any MD until I found a neurosurgeon who has heard of csf leak. People thought I was nuts!!
He admitted me and mri showed bilat extra-axial fluid collection,sagging of the whole brain,narrowing of midbrain/pons angle,flattening of ant. aspect of pons,borderline displacement of cerebellar tonsils. Diffuse enhancement of the pachymeninges.ventricular system normal.slight distortion of the suprasellar cistern with borderline right uncal herniation and also basal cistern with left uncal herniation.MRV shows prominent right transverse sinus convex borders consistent with venous congestion.Interpetation is "findings suggestive of intracranial hypotension with impending uncal herniation" Mri spine myelogram normal. This imaging was done with contrast. Impending uncal herniation-scary!
An epidural patch was done next day at I'd guess L4 and it was the most amazing thing! Halfway through the injection my headache which was really bad vanished and I felt a great feeling of power go through my body. I was completely cured in ten seconds! It was a miracle!
With orthostatic disabling headaches, bilat. symmetric sliver hygromas on ct scan, mri report, and instant cure with first epidural patch I think there is no doubt that the problem was low pressure csf with probable leak, no source found. Unfortunately the patch worked for about 3 wks then things got worse and worse with eventual constant intractable severe headaches. One night headache was so bad I went to emerg to get some relief- 2 IV doses morphine did not touch me and it took IV dilaudid to make me silly and get rid of my pain. The next 6 months were bad. As stated previous note my saviour Dr. Peng came into my life and I rejoined the world. It took 3 months to get back into some sort of shape.
No I have not had a nuclear cistenography. My MDs thought the diagnosis was firm and I agree.
I understand the patch is not to treat increased csf pressure. My concern is using a fibrin patch in a patient with increased pressure may further elevate the pressure (a beaver dam blocking a river) and cause worse problems.
Starting today I have increased Diamox to 1gm bid. I'll see if I can handle it and keep it there for about 10 days. I'll see my neurologist let him look in my eyes and ask for a referral to someone who has a better idea about my case.
Do you want me to keep you abreast? I would be glad to. I value your advice.
Again-thank you.
ps- My last couple of mris over the past 2 yrs have improved to being normal. But as you say-treat the patient not the mri.
Today is the first day in 3 weeks where it's not completely freezing outside in Torontol(and we are used to the cold) but it's snowing a lot. The cars are covered etc etc. I hope you are in a warmer place and not XXXX!
Thanks again XXXX
Again thank you for your reply. I think there are a few misunderstandings here. I think I told you that my investigations for source of csf leak were negative. However the diagnosis was not in doubt. I do not know how to transfer cd material but I will give you the highlites of mri May 24 2011- I first had a ct scan about 5 wks previous that showed bilat sliver thin subdural ?hygromas ?hematomas? I was Rx'd for that conservatively and continued to get massive orthostatic headaches. I knew what I had but could not convince any MD until I found a neurosurgeon who has heard of csf leak. People thought I was nuts!!
He admitted me and mri showed bilat extra-axial fluid collection,sagging of the whole brain,narrowing of midbrain/pons angle,flattening of ant. aspect of pons,borderline displacement of cerebellar tonsils. Diffuse enhancement of the pachymeninges.ventricular system normal.slight distortion of the suprasellar cistern with borderline right uncal herniation and also basal cistern with left uncal herniation.MRV shows prominent right transverse sinus convex borders consistent with venous congestion.Interpetation is "findings suggestive of intracranial hypotension with impending uncal herniation" Mri spine myelogram normal. This imaging was done with contrast. Impending uncal herniation-scary!
An epidural patch was done next day at I'd guess L4 and it was the most amazing thing! Halfway through the injection my headache which was really bad vanished and I felt a great feeling of power go through my body. I was completely cured in ten seconds! It was a miracle!
With orthostatic disabling headaches, bilat. symmetric sliver hygromas on ct scan, mri report, and instant cure with first epidural patch I think there is no doubt that the problem was low pressure csf with probable leak, no source found. Unfortunately the patch worked for about 3 wks then things got worse and worse with eventual constant intractable severe headaches. One night headache was so bad I went to emerg to get some relief- 2 IV doses morphine did not touch me and it took IV dilaudid to make me silly and get rid of my pain. The next 6 months were bad. As stated previous note my saviour Dr. Peng came into my life and I rejoined the world. It took 3 months to get back into some sort of shape.
No I have not had a nuclear cistenography. My MDs thought the diagnosis was firm and I agree.
I understand the patch is not to treat increased csf pressure. My concern is using a fibrin patch in a patient with increased pressure may further elevate the pressure (a beaver dam blocking a river) and cause worse problems.
Starting today I have increased Diamox to 1gm bid. I'll see if I can handle it and keep it there for about 10 days. I'll see my neurologist let him look in my eyes and ask for a referral to someone who has a better idea about my case.
Do you want me to keep you abreast? I would be glad to. I value your advice.
Again-thank you.
ps- My last couple of mris over the past 2 yrs have improved to being normal. But as you say-treat the patient not the mri.
Today is the first day in 3 weeks where it's not completely freezing outside in Torontol(and we are used to the cold) but it's snowing a lot. The cars are covered etc etc. I hope you are in a warmer place and not XXXX!
Thanks again XXXX
Brief Answer:
Its crystal clear now.Continue Diamox and observe.Keep in touch.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing exhaustive details.I appreciate.
The whole picture is crystal clear now.MRI Brain had enough of indirect evidences supporting CSF leak.Nuclear cisternography if done,would have picked up the leak.
Plan-
Please continue the Diamox and keep observant about your symptoms.CSF monitoring can be done after another 6 months.
Fibrin patch will not increase the CSF pressure.But,if your symptoms are not much and MRI has also improved,please discuss well before getting the patch done.
I surely want to follow you up.Please continue in this thread itself,whenever you want to get in touch.Alternatively,you can send me a direct query at-
http://doctor.healthcaremagic.com/doctors/dr-ajay-panwar/69273
I live at New XXXXXXX and the seasons keep changing here.Winters are over and summers are beginning.
Hope I have answered your query.If you have some follow-up questions,I shall be glad to answer.
Dr.Ajay Panwar,
MD,DM(Neurology)
Its crystal clear now.Continue Diamox and observe.Keep in touch.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing exhaustive details.I appreciate.
The whole picture is crystal clear now.MRI Brain had enough of indirect evidences supporting CSF leak.Nuclear cisternography if done,would have picked up the leak.
Plan-
Please continue the Diamox and keep observant about your symptoms.CSF monitoring can be done after another 6 months.
Fibrin patch will not increase the CSF pressure.But,if your symptoms are not much and MRI has also improved,please discuss well before getting the patch done.
I surely want to follow you up.Please continue in this thread itself,whenever you want to get in touch.Alternatively,you can send me a direct query at-
http://doctor.healthcaremagic.com/doctors/dr-ajay-panwar/69273
I live at New XXXXXXX and the seasons keep changing here.Winters are over and summers are beginning.
Hope I have answered your query.If you have some follow-up questions,I shall be glad to answer.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Yogesh D
Dear Dr.Panwar
I will keep you in touch and thank you for your responses.I have been in New XXXXXXX about ten years ago.I suppose it's changed. When I was ther the only traffic lights were at the airport area. Of course the city was very interesting especially Old XXXXXXX
All the best and again I thank you for taking an interest in me.
Best regards XXXX
I will keep you in touch and thank you for your responses.I have been in New XXXXXXX about ten years ago.I suppose it's changed. When I was ther the only traffic lights were at the airport area. Of course the city was very interesting especially Old XXXXXXX
All the best and again I thank you for taking an interest in me.
Best regards XXXX
Brief Answer:
Its a pleasure really to be in touch with you.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
Its a real pleasure for me to have been across you on HCM and it feels good that you are another medico.In a way,we are the members of a family.
You must have been to New XXXXXXX regarding some conference,I guess.I am really happy to know that you visited my city sometime.May be,Ill be there sometime in your city in future.
I am really glad to have you in follow-up.
Thanks and Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Its a pleasure really to be in touch with you.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
Its a real pleasure for me to have been across you on HCM and it feels good that you are another medico.In a way,we are the members of a family.
You must have been to New XXXXXXX regarding some conference,I guess.I am really happy to know that you visited my city sometime.May be,Ill be there sometime in your city in future.
I am really glad to have you in follow-up.
Thanks and Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Raju A.T
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