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GingerLox
01-09-2007, 02:10 AM
Hello CSF leaker Forum.....................I didn't know exactly where to jump in on the posts since so many were of interest to me..........but I especially wanted to give a call out to Ed. Reading your post is as if I am reading my own story!

There used to be a braintalk forum of which I was a member, but it was taken down and all was started from scratch again, including registration. There were several cranial leakers that would post on it. They still are not on this forum as of yet. I hope they rejoin so that we can see what progress they have made and how they got there. I do recognize Dagaz as a past forum member with many spinal csf leaks. I see that you are still fighting this CSF battle, eh, I am so very sorry.

Let me fill in the background a little........................Connecting the dots to determine which order of health events took place first, somewhat like which came first the chicken or the egg, has sent me off into many different directions to find answers. Here is where things stand to date;

14 years ago I fell on the ice. I momentarily bent my spinal cord in a 90 degree angle. At the time I experienced spinal shock and was paralyzed for 15 minutes. I was taken by ambulance to the hospital, and was evaluated and xrayed. It was thought that I had badly sprained my back, and that was thought to be the end of that. For 6 months following, I had a warm, spreading sensation coming from the site of the bend. We had thought that I was bleeding internally from the area, but no blood was seen on further scanning. In retrospect, I am sure that was a spinal csf leak that finally healed on its own.

Fast forward a bit..........I started having many health problems. Problems that included miscarriage, heart problems which eventually landed me with a pacemaker, kidney failure, lung disease, hypothyroid, pituitary diabetes insipidus, vasculitis, blood disorders, and so on. You name the organ system, it was affected. After the safe birth of my second live birth high risk pregnancy, I was diagnosed with Lupus.

Fast forward again.........I was diagnosed with Dysautonomia. Dysautonomia is the malfunction/damage to the brainstem which controls the body's automatic functions such as blood pressure, heartrate, body temperature, digestive systems, bladder control........basically it was told to me that anything that needs to squeeze to work was now impaired. The brainstem is at the base of the brain and top of the spinal cord which was apparently injured years before in that bad fall. I went to Mayo regarding autonomic impairment and found it to be a disappointing visit. I have a doc in Ohio that is a specialist in this little understood area of the brain

So 3 years ago........after many years of being treated by ENT doctors as having chronic sinusitis......it has been determined that I have a CSF leak. I am now sure that this leak is related to my original fall. I have been to many local docs who referred me on as they each saw the nose leak in progress. I am now with a doctor in Kansas City who is a world class doc as well as person. He has asked me each visit to stick it out with him....typically it is the other way around! He has been baffled given that I have bilateral rhinorrhea and bilateral otorrhea. By the way, I saw Dr. Mokri, and he is a great guy, no doubt a great physician, but he dismissed the diagnosis several years ago when one of his colleague's told me that there was no way I could know if there was fluid in my ears without a perforation in the eardrum. Although, I did have a positive beta transferrin reading on one of my pledgetts used during my cisternogram. I was disappointed in them to say the least.

My current ENT did a flourescein dye test (which resulted in a secondary csf leak and blood patch) last year, but after my visit with him today, he is scheduling another flourescein and cisternogram within the next couple of weeks.

My symptoms are surprisingly, not severe headaches, fluid running in my ears and into my sinuses, and a recent increase in fluid down the back of my throat, where I must swallow to get it down. I can actually record the sound of the fluid dripping through my ears. My husband can hear it with a stethoscope. It makes me want to return to Mayo just so they can know that fluid in the ears is possible! Unlike Ed, I have been able to collect the fluid from my nose, and I have yet to get it to show positive for Beta Tranferrin, and I believe this is because the fluid that comes through my sinuses is secondary from the eustachian tube. The fluid collects in the sinuses when I am laying down (the reservoir sign) and comes out when I am upright. If the fluid is in the sinuses until I am upright, and then comes out later the 3 hour threshold for protein exposure is up....hence, the protein can no longer be found. Although, I am positive for glucose.

The worst part, which my doctor finds hard to explain, is that I can feel the fluid seep into tissue as if it has found a route out into my body. I feel the warm, itching, creeping, burning (like salt on raw tissue), feeling in my shoulder blades, in between the blades, in my left breast which swells with fluid, and recently in my lower back. I had a mammogram, a carotid artery scan, and echocardiogram to try to figure out what was causing the sensation. Then I realized if I layed on the side of my head with the ear that leaked the most, I would wake up with these symptoms on that side of my body. At night, I wake up with night sweats and I now feel that too, this is my body removing the excess fluid from this tissue. The symptoms improve after a good fever/sweat. And very oddly, before the leak increased to the degree it is now, I would suffer with fluid buildup above my ear, even on the scalp. My husband said that my head actually smelled like mildew. I would have small bumps on my scalp full of fluid just waiting to drain. Now there is little buildup and more direct draining through the eustachian tube. The days in which I drain less, I get a headache with the scalp bumps. Once I lie down on the offending ear, it releases the pressure.

And to bring this full circle.........I think the fluid that escapes into my tissue either irritates my Lupus or caused it in the first place, with its protein that doesn't belong in other body tissue than within the dura. I believe when the leak is finally found it will be at the base of the skull, next to the brainstem.........

Maybe all because of that one icy morning!

thanks for my moment to explain

GingerLox

(and Ed, if it helps I think that the fluid pressure coming out from the skull is less susceptible to menengitis given the theory that was mentioned that the germs would have trouble swimming against the stream. I have found that when I begin a cold, the fluid washes away the germs quite quickly. I would suggest that you stay somewhat upright while fighting your current infection to try to work with gravity to keep the infection from going back into the area of the leak.......like plumbing.) The Mayo neurosurgeon told me to know the signs of menengitis and be hypervigilant in the event that any symptoms arise.

Edward
01-09-2007, 12:09 PM
Hello GingerLox,

I just read your story quickly and will read it again when I have more time but I just had to give you a quick inititial response. I do not know if I mentioned this or not in this forum (I do not think so because I figured it was not terribly relevant to CSF leak issues) but for the last several years I have had numerous symptoms of an autoimmune disease but have not been able to receive a diagnosis. I suffer from raynauds, heart arrythmias, an accelerated heart rate, overall poor circulation (I just run cold compared to what I used to be like), low blood counts, and many many other problems. The past several years I have seen numerous doctors but despite receiving individual diagnoses for several of the symptoms, I have not been able to obtain a unifying diagnosis (like lupus). I had finally come to the point where I was just going to live as best I could and try to stay away from the doctors and then this stupid skull fracture and leak occurred. I have a theory that part of the reason my leak is taking so long to heal is because of my autoimmune condition. So, in your case your leak may have caused your autoimmune disease and in my case my autoimmune disease may be contributing to my leak.

I have so many health problems now I am losing track. I am only in my mid-40's but I feel like I am going on 80! It used to be I just had the autoimmune to worry about (of course that itself encompasses several conditions that need monitoring). Then I got the skull fracture and the leak to worry about. Then I got this stupid sinus infection. I feel like the "Gods are against me." My plan (I always have to have a plan of some kind) is to get the sinus infection taken care of first and then concentrate on the leak. I am going to try to get into Mayo but after reading your experiences, I am not as excited at that prospect.

Well, I have to go but I look forward to talking to you more.

-Ed.

GingerLox
01-09-2007, 04:01 PM
Dear Ed...........I found a very important article the other night on basilar skull fractures. It mentioned that when there is a fracture at the base of the skull, that almost always there will be a tear in the dura.

Basilar Skull Fracture "In essence, a basilar fracture is a linear fracture at the base of the skull. It usually is associated with a dural tear and is found at specific points on the skull base."

http://www.emedicine.com/med/topic2894.htm

The fact that they have identified your fracture site, will probably add validity to your case if you were to pursue Mayo. All I had when I went there was the periodic fluid draining from my nose, and my word that I could hear and feel fluid draining through my ears. The latter is what they couldn't wrap their minds around. I think their expertise is the more common cranial csf leak that originates in the sinuses. But they may have had other cases of otorrhea since I was there several years ago that have educated them further.

As for your Lupus..........did you ever have a positive ANA? Now that your leak is in full swing, you may have them test you again for that blood antibody. My Lupus may have been there regardless also, and it is likely that the csf leak is just keeping it busy! Have they ever run a C-ANCA or P-ANCA antibody test on you to see if you have that type of vasculitis? Autoimmune vasculitis can be associated with Lupus, or be its own separate entity. You might request that test. It sounds as though the symptoms you mentioned so far could be related to a systemic vasculitis. It took them 10 years to run that additionaly test on me. I guess it fell through the cracks. Obviously the vasculitis can affect any organ system since they all rely on one's circulation. Just a thought!

I look forward to talking with you more
GingerLox

PainInTheNeck
01-09-2007, 09:17 PM
Ok....now I am freaking out a little bit here. You guys may be head leakers but you are "ringing" some bells with me too. I too have had a history of sinus infections and sinus surgery. I also have poor circulation and my doc has "suggested" I many have raynauds. We are having an unusually warm winter here in Indiana and so the circulation problems have not affected me much this winter yet. My typical winters ( for the past 25 years..I am 45 yrs old now) have included cracking bleeding fingers tips and swollen toes that first become hot and itchy and then the skin dies and turns white followed by a bruised look until summer when the warm air finally seems to get them well. I have also fought a rare thing for years in that my toes are extremely sensitive. I used to think I was just clumsy and always stubbing my toes but then one day I dropped a penny on my bare toe and it felt like I had dropped a brick on it. That is when my doc suggested raynauds...? So anyway...really curious if this is the circulation or lupus type symptoms you all ever experience.

GingerLox
01-09-2007, 09:50 PM
Hi Pain in the Neck............Oh my goodness, bless your heart, have they ever run the tests for Raynaud's on you? Have you ever seen a rheumatologist regarding the care of your circulation problem? Yes, I too have raynaud's that is secondary in my case to my Lupus. In my case this is not as severe as you have mentioned for you. The good thing for you is that it sounds like your raynaud's is not progressive, and strengthening with time. That means that it is probably not a systemic disease affecting your whole body. Do you have other organ health issues that seem to be affected by your circulation?
Raynaud's can often be associated with Lupus and vasculitis, but it is also a disease that can stand alone, and be a primary disorder.
There is an antibody that can be tested for in Raynaud's disease. It, too, is an autoimmune disease. It affects the circulation to your hands and feet. Which in turn will make you especially cold in the winter.
There is also a test called the "capillary test" where the doc looks at your fingertips under a certain light to check for blood return.

Oh, and I am 44 years old!

Fondly
GingerLox

Edward
01-10-2007, 12:49 PM
Hi GingerLox and Shelly,

I am not feeling as sorry for myself now knowing that there are actually other people out there who, like me, have not only a CSF leak but also an autoimmune disease/condition also. How lucky are we anyway?

I wanted to respond to a few things you both brought up. First off, Shelly I think that GingerLox is providing some good advice. It probably would be good for you to see a rheumatologist. My raynaud's is different than yours and is different than the typical raynauds for that matter. Mine is characterized primarily by very cold hands and especially my feet and toes. My toes and the bottoms of my feet are commonly a dusky purple color due to reduced blood flow. Except for the hottest part of the summer, I contstantly have to use those little chemical hand warmers which I stuff in the end of my shoes to keep my toes comfy. I was diagnosed with "raynauds" through doppler-flow vascular testing whereby they could actually see the greatly reduced blood flow to my hands and feet. But what they did not see is the fact that this blood flow problem in my case is systemic. I know if affects me elsewhere because I run so much colder than I used to and I notice areas of poor circulation on my body surface if I am out in the cold air. I have to rub these areas or take a hot shower to get the circulation going again.

Okay, enough about raynauds. GingerLox, I went back and read your posts here and I wanted to respond to a few things of special interest. First, as far as bilateral otorrhea goes - I have read that people can get a certain type of skull base fracture called a bilateral transverse petrous fracture. I am a little in over my head here but as I understand it a transverse fracture means that the fracture is running parallel to the plane of your face rather than perpendicular to the plane of your face. And if it is a petrous fracture that means it is in the petrous portion of the temporal bone. And if it is a bilateral fracture that means literally it has affected both sides of your skull - in both petrous bones. I am not a medical person and so this is just my understanding from what little I have been able to find on the internet. But, the point is that with the just the "right" type of injury a person certainly could get bilateral CSF otorrhea.

I do not understand Mayo telling you that you cannot know there is fluid in your ears! That does not even make sense. There is absolutely no question about it in me. When it happens it is literally like someone turned on a slow dripping faucet inside my ear. The fluid s-l-o-w-l-y and agonizingly oozes its way into and through my ear and finally "appears" at the back of my throat with little drops that quickly fall down the back of my throat. I have had times where both ears will go from being normal to suddenly having that faucet switched on. It is like the pressure in my head reaches a certain point and then it starts oozing out - like a release valve or something.

Thanks for the link on the fractures. I have read in many places that skull base fractures are difficult to actually find even using CT-scanning. In my case, they did find one fracture but it was the one up by my orbit which was far away from where they saw the pneumocephalous (air pocket inside my skull). The air pocket was directly adjacent to my left mastoid but they could not see the actual fracture in that area. The radiologists report even said specifically that the intracranial air pocket was proof there was a fracture but that they could not see the actual fracture on the scan. I am theorizing that they are not only not seeing that fracture but they also are not seeing the fracture on the opposite side of my head which is causing my other ear to be affected.

Finally, thanks for your tips on the antibody tests. You know at this point I almost don't care anymore if I have a name for my autoimmune. There is nothing they can really do anyway to stop or slow autoimmunes. They pretty much just treat symptoms. A few years ago I would not have said that as I was fighting all the time for recognition of the problem. I guess I have been worn down by the big medical establishment "machine." One thing I have learned throughout having my autoimmune and now having this CSF leak, is that doctors are apparently not taught as part of their training that medical knowledge is finite (for example 30 years ago nobody even knew fibromyalgia existed) and that they will encounter many patients in the course of their career that will have legitimate medical problems and diseases that cannot be diagnosed. And even if the doctor wanted to try to dig a little deeper and help you, typically they cannot do so anyway because they are so hurried and have so many appointments packed into their day. So, these more-difficult-to-diagnose patients then either get diagnosed with "anxiety" or they get shuffled off to another doctor. I will get off my soap box now but truly, in my opinion, our system is not set up well to help the difficult-to-diagnose patient. But maybe that is just the way it is and I should stop whining!:D

There is one thing I am curious about with your situation GingerLox. So, when you went to Mayo you were already diagnosed with a CSF leak, right? So, what did Mayo tell you to do about the leak? Or, did they believe there was no leak? (I am just trying to understand because it seems like you have gone quite some time between being diagnosed with the leak and now and yet your doctors have apparently not recommended surgery or anything to try to cure the leak. Is that because they don't know where the leak is?). Thanks....just trying to understand your situation.

Good talking to you. Have a great day.

-Ed.

PainInTheNeck
01-11-2007, 05:55 PM
OK....a couple quik questions.....I know I can research this but I don't really want to...lol!!! Just want to know your thoughts or what you have experienced. My body temperature runs at least a degree below normal on the thermometer. Is that indicative of raynauds? My feet and hands get very cold in winter but the rest of my body is usually too hot. Going out in cold weather I am most comfortable if I wear heavy socks and gloves but light sweater instead of a coat. In my thinking I just have thought my body keeps part of me too hot and the other too cold but maybe it means the reduced blood flow to hands and feet cause too much bloodflow in other parts of my body thus causing overheating in them.

Also - as related to raynauds symdrome....is early adulthood high blood pressure a symptom? I have had "borderline" hypertension since I was a teenager and have now been diagnosed with high blood pressure and on meds for over 5 years now.

I know I am getting a little off topic here but hope thats ok.

GingerLox
01-11-2007, 07:49 PM
Dear Ed~

Yes......it has been a VERY long time.

To begin with I cannot have an MRI given that I have a pacemaker, so some of the non-invasive specialized testing that can be done in locating the leak, cannot take place.

Secondly, the doctors have spent some time trying to disprove the leak theory and then ultimately were not able to. There are enough positive test results now for them to move forward with a serious attempt to locate the exact leak site. They worry about my other health issues by being too diligent. My symptoms have gradually increased in recent months, so they feel it is becoming less of a choice and more of a necessity now.

There have been doctors, who have seen me since Mayo and witnessed the fluid actively leaking through my nose. Each time I was immediately passed on to the next more specialized doctor. Honestly, I have been treated like a hot potato..............that's why I love my most recent doctor. He just puts his oven mits on, lol!

To make a long story short (which is hard for me, lol).........they are sure there is a leak, but cannot locate it and do not want to go in exploring surgically until they are forced to by episodic meningitis. Again, I have dodged the proverbial meningitis bullet thus far. My gut tells me that they are still focusing too much on the nose fluid, and not enough on a location that would involve leakage through the ears. The otorrhea source has been MY brick wall.

BTW.........I have found that the less information that I provide up front to the doctors, the more "palatable" the situation is for them. I give them just a tidbit more information each time. Sometimes its as if they can't wrap their mind around all of it at once. Who could blame them, huh? This is the case with all my doctors!

~GingerLox

GingerLox
01-11-2007, 08:28 PM
Dear Pain-in-the-Neck~ (it is hard for me to call you that)

It sounds as though you have a classic case of Raynaud's. It even sounds somewhat severe! They always told us Lupus people the classic...red, white, and blue signs of Raynaud's. Those are references to skin color. Not to mention the sores that you are getting.

I'm not sure how the low body temp works into Raynaud's, but I have low body temp because of my Dysautonomia. Perhaps because your peripheral blood/tissue never gets the chance to really warm up and when that mixes with warmer than normal body/core temperatures it comes up cooler than normal. Just a guess. Autoimmune disorders typically cause you to run a slight fever as your body overcompensates for the antibody attack on your system. (like running a fever to rid yourself from a flu bug, your immune system is overreacting all the time.) That's why it would be beneficial to see if you have a primary Raynaud's that is caused by an antibody of one type or another. Cardiolipin antibodies is another source to check into!

Do you ever get night sweats? Oh, and I assume you do not have diabetes? As Diabetes circulation can imitate Raynaud's.

As for a question being relevant, sometimes in the piecing together of puzzle pieces we find that our disease can all be connected back to one source. You never know!

Here are a couple articles regarding raynaud's. E-medicine is always my favorite source for research.

Keep those fingers and toes dry and warm!!!!!!!!!!

http://www.emedicine.com/aaem/topic375.htm
http://www.emedicine.com/med/topic1993.htm

~GingerLox

PainInTheNeck
01-11-2007, 10:40 PM
Hey Ginger...

I just read the articles. That was really thoughtful of you to find and give me those links. It is strange that I actually have not had any flare ups of the toe discoloration or swelling this year. Usually I would have been fight ing that for the last couple of months. The reason for the sores on my fingers is actually because the skin splits open at the tips if I ever let them get cold. I am just so used to these things going on every winter with my fingers and toes.

Just curious if any of you experience "exagerated pain" like I have in my toes. It doesn't seem to occur anywhere else but as I stated in an earlier post...if I drop a penny on my toe I am in severe pain. The hopping around trying to catch my breathe kind of pain. This is something that has been a part of my life ever since I can remember.

Ginger...thank you again!

GingerLox
01-11-2007, 11:36 PM
Yes.......................I know exactly what you are talking about with the exaggerated pain on the toes, or fingers for that matter. And sometimes I will have a fingertip be very sensitive for a few days without even hurting it. This can be in any temperature.

When I pick up an icecube, sometimes it hurts like crazy in response to the cold. When I hold a cold drink for too long, it will cause "cold pain" also. It's a very strange phenomenon!

I think that the severe pain that you are having that is not associated with a cold temperature, like you mentioned with your toe, might be because your circulation is working well in warm temperatures and blood supply issues have damaged your nerves causing them to become ultra sensitive when the toes or fingers have the appropriate amount of blood running to it. Kind of like a tooth that has gone bad, that is starting to lose its circulation and when it throbs because the blood supply is trying to heal it but actually exaggerates the pain.

I'm not sure if I am making any sense.......but I hope this helps.

~Ginger

Edward
01-12-2007, 12:39 PM
Thanks GingerLox,

Now at least I understand more about your situation. I am a pro-active person when it comes to problems like this. When I see a problem I want to solve it. So living with a CSF leak is a hard thing for me to accept especially when you see over and over again (at least from what I've seen on the internet) that the risk of meningitis is so great. I am so glad you found a good doctor - sounds like the kind of doc we all want to have!

Getting back to that meningitis thing for a moment though. You know I am wondering if the incidence of meningitis in CSF leaks could be overstated. What I mean is that how do they know how many people have CSF leaks that do not get meningitis? Sure, they are going to know about the people with large, noticeable leaks and whether they do or do not get meningitis. But, from my reading it sounds like many leaks are subtle and people may not even know they have them. So, in many cases the only way they would probably find these subtle leaks is if someone had meningitis. So, when you read that 25-50% of untreated CSF leaks result in meningitis, this may not be so because they may not be factoring in all the unknown cases of CSF leaks with no menigitis. I could be way off base here but at least this theory makes me feel better!:D

Take care...Ed.