Leak in Spinal Fluid Leads to 'Sagging Brain'

EMBARGOED FOR RELEASE UNTIL MONDAY, JUNE 22, 1998

For more information contact Sarah Parsons at (612) 695-2732 or [email protected]

Leak in Spinal Fluid Leads to ëSagging Brainí

ST. PAUL, MN (June 22, 1998) A case of a 51-year-old man with severe headaches and sleepiness that eventually left him unable to function puzzled doctors for months. Their solution is published in the June issue of Neurology, the scientific journal of the American Academy of Neurology.

A computer programmer in excellent health, the man developed dull, constant headaches. Within a few weeks they were so severe that he couldnít work. Doctors in his hometown suspected he had a condition called spontaneous intracranial hypotension, the result of a hole or tear in the sac around the spinal cord causing fluid to leak out. The subsequent loss of pressure causes headaches and other symptoms. In many people, the hole repairs itself and the symptoms go away.

For those who still have symptoms after bed rest, doctors inject some of the patientís own blood into the space around the spine (the same space used to administer epidural anesthesia during labor). The blood flows up and down the spine and seals the hole. Doctors tried an epidural blood patch on this man, and his headache went away. But three days later, it was back. They tried it again and nothing happened.

He started getting worse, with a declining level of consciousness, memory problems and incontinence. His doctors then suspected an infectious or inflammatory process, such as encephalitis, but they were unable to make a definitive diagnosis. He was admitted to a convalescent home, where his condition deteriorated. His wife, unwilling to accept that he would be in the home for the rest of his life, took him to the University of California, San Francisco ñ far from home and outside their insurance plan.

"It became clear that the original diagnosis was probably correct, but that he had an extreme case," said neurologist Samuel Pleasure. "His brain was pulled down through the opening in the bottom of the skull, squeezing the portion of the brain involved in keeping him awake and alert. He didnít lose consciousness ñ he wasnít in a coma. But he was inattentive and apathetic all the time. If he woke up, he might say a word or two or make a gesture, then drift off. Occasionally he would get up and walk out to the nursesí station."

Pleasure and his colleagues knew they had to find the hole and fix it. In the meantime, they tried a temporary solution ñ giving him fluid through a plastic tube in the space around his spine.

"Within six hours, he was strikingly more alert and interactive," Pleasure said. "By the next morning, he was almost normal, except for some memory problems. He woke up and said, ëWhere am I? Whatís going on?í Then he asked for a beer."

The doctors performed tests to look for the leak. They took X-rays after injecting a dye into the sac surrounding the spinal cord (called a myelogram), looking for the leak. They did a lengthy MRI scan of the entire spine. But still they found no hole.

So they gave him another, high-volume blood patch. He became alert and had no symptoms, so they sent him home. A week later, the headache was back, along with some confusion. The neuroradiologist painstakingly searched the manís tests again, and found a suspicious area. Another myelogram was performed focusing on that area, and the leak was found.

"The hole was closed through surgery, and heís been fine ever since," Pleasure said. "Heís back to work as a computer programmer and his memory is back to normal."

Pleasure said doctors and patientsí families should learn from this that some cases of cognitive decline are treatable. "If there is no diagnosis or if the decline is labeled as ëdementiaí without the appropriate tests, family members should ask for additional testing and to see a neurologist," he said. "If this manís wife hadnít pushed for some kind of answer, I donít know where he would be right now."

Improving care for patients with neurological disorders through education and research is the goal of the American Academy of Neurology, an association of more than 15,000 neurologists and neuroscience professionals.

- end -