Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties
151 Doctors Online

By proceeding, I accept the Terms and Conditions

Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

HCM Blog Instant Access to Doctors
HCM BlogQuestions Answered
HCM Blog Satisfaction

What causes increased pressure in the ear and headache despite taking Diamox?

Answered by
Dr.
Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3650 Questions

default
Posted on Fri, 26 Aug 2016 in General Health
Question: I had the second blood patch on Friday 7-29-16.

I'm still not okay after 3 days of laying flat. This is what I sent my ENT-skull based surgeon. I went back to the Doctor that did the first LP to do the second blood patch. The anesthesiologist said that there is only about a 50% chance that the second blood patch will work. But I felt like he wasn't telling the truth as he is good friends with my ENT. The ENT was a little mad at me before I went through with the surgery over a year ago because I asked him if HA bone Cement could crack after he repaired my ears. If it would crack over the superior canal and or on my skull as this is the only thing he uses to close the hole in my head. He did not like that at all. But I asked him in confident.

I still don't fill right. I don't fill like I did before the LP. My XXXXXXX is not working the same. It like it's slow to compute information coming in to it. I used to be able to fill the pressure against the RWR but now I don't fill any pressure after standing up for a while. Like the inner ears are very relaxed with not pressure. If I try and do the valsalva maneuver very gently I don't fill any pressure in my head and the ears will not stick or pressurize at all.

My first day back at work was originally going to be Monday 7-18. But I didn't fill well after being on my feet. On on 7-20 is when I took the smallest amount of Diamox it caused me to bottom out pretty bad. I have not taking any since then. But the Diamox did bring on the symptoms real bad. Locked my XXXXXXX up for over 8 hours.

I laid flat up until 3p yesterday. I got up and tried some things but my XXXXXXX was very slow and the headache did come one more and more as I was on my feet. I was on my feet for a total of 8hrs and I did have a pretty bad head ache when I laid down.

I was going to try and go back to work today but Medical at VW said I would need a doctors release to come back because I've been out for two weeks. I did not know until until I called them this afternoon. They said I could come back in the next couple days if I can get a release from my Doctor. I would have to of had a release today by 4pm to have gone in by 6pm. But I still don't fill well enough to go back. I am also weak and tired. If I lay down the confusion and the head ache that is coming on subsides.

(My Work said since I've been out for two weeks I should take out a short term leave). They told me to call XXXXXXX Mutual to set it up and they would get in touch with you. They said this would protect my job even if I ran out of FMLA hours. I have 50hrs remaining.

I got an appointment to see my PCP this Friday 8-5 at 2pm. I'm going to try and see if I can get in any sooner. But I'm continuing to lay flat a lot and get up for a little while and try some walking to see how that effects me. So far the input to my Brain is off and seems to be mixed input when I try to do normal things. It's like it is delayed and confused. If it's from Low ICP? I don't have much of an appetite and don't fill like eating either. Brain is constantly confused.

I don't know what else to do after this. I don't know if I should check my self into a Hospital that deals with the Brain?

I don't fill any resistance in my ears at all. No pressure after being on my feet. I fill like I have to over process everything to be able to think.

I've been to the ER 4 times and they do not know what to do. On of them was for the Blood Patch back on Saturday 7-16-16.

I know I'm outside the normal range already for a blood patch to work but I'm being 100% honest with you. I'm also lost for words and want to get back to the way I was before.

Can someone go through both sides of the Dura and cause a leak in the back so the blood patch doesn't work? I really don't know what to do. It's been 3 weeks total. Say if it is a leak what would be the next step to take? Possibly go to Emory in Atlanta? I'm not sure
doctor
Answered by Dr. Olsi Taka 6 hours later
Brief Answer:
Read below.

Detailed Answer:
Hello again!

I am sorry to see that you still are not feeling well. I was really hoping for the second blood patch to work. I still have some hope as the blood patch works in two ways, one by increasing the pressure which provides the immediate relief and the other by slowly forming a gelatinous layer which gradually closes the leak. However you describe not to have had any improvement at all and given that you’ve had another one something should have happened.

Regarding your fear of having a dural tear on both sides, the blood patch should have worked on that as well (though with a lower percentage of success), however I do not think that is the case really.

So in terms of there is the fibrin glue which has worked in some cases with failed blood patch. I am not sure if it is something which you will be able to get in an ER though, you might have to be admitted to a neurology service.

The other option is surgery. It is a little difficult to provide success percentage numbers as you request. That is because the publications usually are of small numbers of patients and the techniques used are constantly changing over time as new types of sealants emerge, so figures in publications of a few years ago may not apply now. Success rates are high though, up to 100% in a few case series (although since with small number of patients I would be careful in accepting that – many patients are needed for statistical significance).

However I believe that before speaking of surgery or other measures some type of imaging is necessary, preferably with an MRI of the brain and spine, to look for signs of intracranial hypotension and confirm the presence and site of leakage. Given the protraction of the symptoms even after repeated interventions I think that it is necessary in your case. So you should be referred to a neurology clinic. Regarding where, Emory would be fine as I told you in our last exchange, I do not know what are the referral regulations where you live though, especially given it being in a different state, if not possible or you have to pay large amount of money out of your pocket I would say to go to Vanderbilt which as I said is also well ranked. In terms of how long you should wait, while as I said long term improvement is still possible by the gradual sealing of the leak, I believe you should go ahead with the necessary steps, because there can be waiting times for referrals and imaging to take into account, so you should try to anticipate the meeting with your PCP in order to discuss the necessary procedures.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Olsi Taka 3 days later
I'm still having symptoms. I felt a little better yesturday but whenever I move at my waist leaning over or twisting the symptoms come on and the It makes it hard for the Brain to work. I layed flat for 3 days after the 2nd blood patch. I'm headed down to the Emergancy Room at Emory Hospital in XXXXXXX I'm going to see if they can order the MRI with contrast in the ER. It will be around 6pm so I hope I'm not to late for today. I'm not driving my father is and he is very slow.

Do you think an MRI with contrast is better than without contrast? Or does that matter?

Thank you for all your help. You have been a life saver.
doctor
Answered by Dr. Olsi Taka 31 minutes later
Brief Answer:
Read below.

Detailed Answer:
Hello again! Thank you for your kind words although I do not feel to have deserved being called a life saver really, wish I could have done more for you.

I am glad that you are feeling a little better, perhaps there is hope for the second blood patch to be sealing the tear after all and the lost fluid to be slowly replaced.

Regarding the MRI, it is always better to have it with contrast. It is not that the MRI without contrast doesn't have any value, it can give valuable information, exclude possible complications such as descent of the cerebellar tonsils, collection of fluid under the dural layer etc. So it would be better than nothing to relieve some of the anxiety regarding possible causes of "brain not working right" as you describe it. A contrast exam does give some more information of blood vessels though, as well as thickening and enhancement of the meningeal layers, a possible complication of the low pressure.

Hope things will work out for the best.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,  
Lab Tests
Medical Topics ,   ,  

Recent questions on  Intracranial hypotension

doctor1 MD

I am 60 years old, 5 3 , 135 lbs and have been diagnosed with Intracranial Hypotension. I have seen 3 different neurologists, had 4 MRIs, and am...

doctor1 MD

My wife has a chronic headache nearly every day for the past 14 months or so. The symptoms are mostly pain to the right side and pressure near the...

doctor1 MD

I have been diagnosed w intracranial hypotension n keep headaches the majority of the time. Three wks ago I starte putting two cups of caffeinated...