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Dr. Stan
Dr. Stan, Medical Physician and Surgeon
Category: Medical
Satisfied Customers: 2701
Experience:  Johns Hopkins Fellowship Trained, Certified and Licensed Medical Physician and Surgeon
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How would one image or diagnose a ruptured occipital lymph

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How would one image or diagnose a ruptured occipital lymph node after a neck injury? CSF leak has been ruled out, cultures of clear/cloudy slick/viscous egg white consistency fluid are negative for fungal/bacterial infections and show only normal flora. CT's/MRI's are unremarkable. Fluid flow into right nasopharynx increases after eating, chronic low grade fevers and intractable headache (fluctuations in intensity from moderate to severe), vertigo, and arrhythmia's associated with periods of drainage. Originated from a chiropractic manipulation (self induced) of neck, popping sound in base of skull, sensation of fluid draining and pressure loss inside skull (Mastoid/occipital area) into occipital cervical junction with swelling sensation in right nasopharynx. Swollen area in right naso pharynx eventually ruptured after 6 month period, and has produced fluid 24/7 for past 1.5 years in volumes approaching 0.5 cups daily. Focal neural deficits present, unsteady gait, tremors, facial numbness, numbness in extremities on left side only, blurred vision in right eye after drainage. Impaired gag reflex right side site of swelling/fluid production. Lymphocyte count below normal limits on 5/6 workups. Beginning to wonder if they'll name the condition after me if we don't find a reasonable answer soon. Diagnostic radiologist? ENT's? Head and Neck Surgeon? Oncologist? Pathologist?
Submitted: 6 years ago.
Category: Medical
Expert:  Dr. Stan replied 6 years ago.

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It is likely that your are experiencing the neuropathic symptom involving increased sensitivity and stimulation of the nerves supplying the various glands, including the lacrimal and/or accessory glands with increase tear - causing blurred vision, and the salivary and nasopharyneal glands. Eating will stimulate the muscles of the neck, and can trigger the symptoms. MRI of the venous and lymphatic systems can reveal such rupture of the occipital lymph node. In the meantime, I suggest that you follow-up with your doctor (ENT or Neurologist) for consideration of medication such as Lyrica (pregabalin) or Neurontin (gabapentin) to help normalize the nerve sensitivity and possible stop stimulation of the gland to produce fluid.

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