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What Causes Persistent CSF Leakage, Headache, Brain Swelling And Ear Bleeding?
Question: Hello and thank you, in advance, for your time and help. I'm quite worried and a little freaked out. I had surgery for a cholesteatoma in my right ear on XXXXXXX 15, 2015. When the ENT surgeon went to drill into my skull, my brain had dropped due to erosion of my membrane so they accidentally drilled into my brain and I ended up having emergency brain surgery to repair it. I was in surgery ICU for about 24 hours, then transferred to a regular room for an additional 24 hours or so and the released to go home. I do not have health insurance yet but the ENT surgery portion, tests, ENT Dr. visits and such were covered because of financial qualifications. And also because it's a learning/teaching clinic and hospital. Unfortunately, there are no neurologists within this group. I had a post-op appt. with my ENT Dr. on XXXXXXX 24 but was not scheduled a post-op with the neurologist as I do not have the money to pay him out of pocket and he cannot see me without payment or insurance. I have had a constant headache (usually quite severe upon waking up - an 8 or 9 on the pain scale) since the surgery. I have been on 10-325 mg of oxycodone (Percocet) since XXXXXXX 25. I only take one in the morning and sometimes one at night because I don't like taking pain meds and do not want to get addicted to anything. This has never taken the pain away but does make it tolerable (lowering the pain to between a 4 and 7 that varies). By XXXXXXX 30th I was still having severe fluid leakage, headache (radiating from the back right and outward), and bleeding from my ear to the point it was pooling and running down my face while sleeping. Concerned, I called the ENT Dr. and explained all this. This particular clinic rotates departments and the ENT department was not in that day, only orthopedics, so they could not help me and highly suggested I go the ER right away. I went to ER as instructed. The ER did blood work and a CT scan. I don't know the results of the blood work but since I was released within a few hours I assume it was all within normal range. The CT scan did show I had some swelling of my brain on the back right side. I saw an ENT physician in the ER and he said regarding the ear concern everything was fine and perfectly normal post operative. He did say he could not necessarily speak on the brain concern but that he felt the swelling issue was normal considering the surgery I'd had done so I was released to go home with a prescription of Augmentin and a steroid of which both I took faithfully and finished. I am a stay-at-home mom of a 7 year old girl and 8 year old boy so I do not leave the home to go to a job. This is to explain that I have been home since the surgery and not exerting myself much. No lifting, no driving, no grocery shopping, light housework, etc. Last night I started to wonder if the reason I am still have severe headaches is because I've been on this pain medication for too long and I'm starting to get addicted. So, today I did not take it at all. The ONLY thing I have ingested since being up this morning at 10 a.m. (CST) is about 4 cups of coffee (which is not unusual, I usually drink a couple more than that daily - and this was throughout the day - intermittently between 10 a.m. and 9 p.m., not within a few hours), three 500 mg tablets of generic acetaminophen (taken around 5 p.m.), one 20.6 mg of Prilosec OTC (also around 5 p.m.), 1 link sausage w/mustard (about 6 oz.) with a handful and a half of cool ranch Doritos (around 7 p.m.). FINALLY, to my issue .... This evening around 8:30 I started feeling quite unusual. I can't seem to stop moving my lower jaw to the point where I actually have to concentrate to stop. The best way to describe it is like a cow chewing cud without touching teeth. And to be quite XXXXXXX and try to explain it best, I feel like I'm tripping on LSD. LSD is not something I currently partake in, but I did do it a few times about 15+ years ago which is why I can relate and the best way to describe this feeling. It is really freaking me out and I was hoping someone could give me some advice or insight. Thanks again for your time and advice.
Sincerely,
XXXXXXX XXXX
Sincerely,
XXXXXXX XXXX
Brief Answer:
Ideally, you should be admitted for treatment.
Detailed Answer:
Hi,
Thank you for your query.
1. If the CSF leak has persisted, you should be admitted for further investigation and treatment.
2. With strict bed rest, propped up position, higher antibiotics, medication to reduce the swelling in the brain and measures to reduce CSF production, most patients would recover in a week or two.
3. Since the conservative line of treatment seems to have failed over these three weeks, any CSF leak and swelling of the brain must be addressed. The symptoms that you are experiencing point to the fact that you have not recovered yet.
4. Regarding the pain medication, you are unlikely to get addicted so quickly. In fact the anti-inflammatory effect of these medications (besides the pain killer effect) is equally important, hence you should take them. If the jaw movements are due to interaction between caffeine and your medications, it will subside in a few hours. If this does not, you need a ER visit and a neurology opinion. The ear fluid leak can be tested for Beta 2 transferrin to confirm any CSF leak. AN MRI Brain or a CT cisternography will locate the leak. Details of the earlier repair and operative notes would be helpful.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Ideally, you should be admitted for treatment.
Detailed Answer:
Hi,
Thank you for your query.
1. If the CSF leak has persisted, you should be admitted for further investigation and treatment.
2. With strict bed rest, propped up position, higher antibiotics, medication to reduce the swelling in the brain and measures to reduce CSF production, most patients would recover in a week or two.
3. Since the conservative line of treatment seems to have failed over these three weeks, any CSF leak and swelling of the brain must be addressed. The symptoms that you are experiencing point to the fact that you have not recovered yet.
4. Regarding the pain medication, you are unlikely to get addicted so quickly. In fact the anti-inflammatory effect of these medications (besides the pain killer effect) is equally important, hence you should take them. If the jaw movements are due to interaction between caffeine and your medications, it will subside in a few hours. If this does not, you need a ER visit and a neurology opinion. The ear fluid leak can be tested for Beta 2 transferrin to confirm any CSF leak. AN MRI Brain or a CT cisternography will locate the leak. Details of the earlier repair and operative notes would be helpful.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
In the past I have had two different spinal taps done and both times the hole didn't close and I ended up having a blood patch done within 72 hours. Could this mean that I am more susceptible to CSF leaks than most. And, is it possible to have CSF leak without drainage from the nose, ears, or suture site?
Brief Answer:
Doesn't seem that you are more susceptible to CSF leaks.
Detailed Answer:
Hi,
Thank you for writing back.
1. Your CSF leak seems to be a direct result of the surgery. To rule out raised intracranial tension, the CSF pressure can be measured ot the fundus of the eye can be examined with an ophthalmoscope.
2. Ideally the site of the leak should be closed with fat or cartilage along with fascia and tissue glue.
3. It would really help to go through any scan images and the operative notes.
4. Any CSF leak that does not show as a XXXXXXX fluid is likely to close on its own with conservative treatment.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Doesn't seem that you are more susceptible to CSF leaks.
Detailed Answer:
Hi,
Thank you for writing back.
1. Your CSF leak seems to be a direct result of the surgery. To rule out raised intracranial tension, the CSF pressure can be measured ot the fundus of the eye can be examined with an ophthalmoscope.
2. Ideally the site of the leak should be closed with fat or cartilage along with fascia and tissue glue.
3. It would really help to go through any scan images and the operative notes.
4. Any CSF leak that does not show as a XXXXXXX fluid is likely to close on its own with conservative treatment.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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