Neurology

Ask a neurologist. Get answers to your neurology questions.

Ask a Doctor,
Get an Answer ASAP!

I had a csf leak from a microdiskectomy that went unrepaired…

Customer Question
I had a csf leak...
I had a csf leak from a microdiskectomy that went unrepaired for 14 mos. Despite the repair, I continue to have an audible clicking and popping sound from my head when I change from horizontal to vertical or apply any type of vasalva (video 1). This same sound occurs at random but typically after quick elevation changes or extreme exertion (video 2). My biggest problem is the daily headaches and stiff neck. I have placed two videos online to show you. 1. https://youtu.be/zEirwHwir5Q and 2. https://youtu.be/zEirwHwir5Q. There was some thought this might be sinus related so I had sinuplasty 8 weeks ago. It did not change the problem. I have taken 3 rounds of methylprednisone, 12 months of gabapentin and venlafexin, continuous nasal sprays and steroids. Nothing has helped. Your thoughts are greatly appreciated.
Submitted: 2 years ago.Category: Neurology
Show More
Show Less
Ask Your Own Neurology Question
Customer reply replied 2 years ago
Most recently, the Drs. believe this is some type of myoclonus as a result of the initial discectomy
Customer reply replied 2 years ago
They don't feel that the muscles of the middle ear are large enough to generate such loud audible sounds and are pointing at other muscles that are connected to the skull, hence, the headaches. I still am not certain that this is not spinal fluid related somehow. Pressure or other.
Customer reply replied 2 years ago
I am not sure if I mentioned. But my hearing is impacted as well.
Answered in 17 minutes by:
6/16/2015
Neurologist: DrRussMd, Board Certified MD replied 2 years ago
DrRussMd
DrRussMd, Board Certified MD
Category: Neurology
Satisfied Customers: 65,671
Experience: Internal medicine doctor, diagnose and treat neurology patients, many years
Verified
Hello
What type of physical therapy have you had through all of this.
Ask Your Own Neurology Question
Customer reply replied 2 years ago
I had physical therapy while I had a leak, majority of it was stretching and tenz unit. Since the repair, I have had multiple sessions of acupuncture (10 sessions), 6 months of 3 days per week visiting a PT/Chiropractor. Most of the therapy is stretching neck muscles, pinpoint adjustments using a spring loaded pistol-type tool of the vertibrae, and vibration plate therapy. I have also had a few sessions of cognitive therapy to build awareness and control thoughts due to the pain. Thanks for the question.
Neurologist: DrRussMd, Board Certified MD replied 2 years ago
what about an MRI of the cervical spine recently
Ask Your Own Neurology Question
Customer reply replied 2 years ago
As you know, after the repair in March 2013, I continued to have issues. 12 months following the repair in March 2014, I had another surgery to confirm the leak was repaired. It was, they did not find a leak. At that time, they did a full spine CT and did not see any leaks. That was the last scan I had. I have not had a recent MRI. Last week, an Otoneurologist put in an order for an MRI of the skull base. He wants to rule out the pteragoid muscle as a cause. I have not had the MRI scheduled yet.
Neurologist: DrRussMd, Board Certified MD replied 2 years ago
OK
I don't see anything definite on your videos....
What are you trying to show?
Ask Your Own Neurology Question
Customer reply replied 2 years ago
The videos are to show the frequency and volume of the audible sounds emanating from my head. The first video is to show that I can recreate the sounds by moving from a horizontal to vertical position and back.(I am dropping my head off of the bed and then sitting back up) The second video is to show that the sounds are also being generated at random (without provocation) and in a rhythmic type pattern. (After about 12 seconds you can hear the rhythm of the clicks). I have another video of the back of my mouth that shows the palate is stationary during the clicking that I did not put up. (some Drs initially thought it was palatal myoclonus).
Neurologist: DrRussMd, Board Certified MD replied 2 years ago
I'll opt out for another expert to help you
Ask Your Own Neurology Question
Customer reply replied 2 years ago
I am sorry. Thanks for trying.
Neurologist: Dr. D. Love, Doctor replied 2 years ago
Dr. D. Love
Dr. D. Love, Doctor
Category: Neurology
Satisfied Customers: 19,551
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
Verified
The other expert has opted out.
Obviously, if a doctor examining you cannot localize and identify the source of these clicks, it is unlikely that a doctor can identify the source via a video.
It appears that you placed the camera/microphone in a specific location to best capture the sound, and the location of the microphone certainly is consistent with the sound coming from the face, and the fact that the doctors have been thinking about the sinuses or facial or chewing muscles. It would be unusual for clicks from these locations to be related to cervical disease. These muscles are served by cranial nerves, so are not affected by cervical disease. The muscles along the back of the head, under the scalp are served by nerves that arise from the cervical spine, but the apparent location of these clicks is far from the muscles on the back of the head.
If it is now thought that the sinuses have been fully addressed, then it would be appropriate to concentrate on the muscles, as that would be the primary remaining structures in this locations.
If th MRI does not clarify the source of the symptoms, another option that may be able to help identify the source would be to consider serial nerve blocks. For example, it many ease symptoms related to the pterygoid muscle to perform a block of the nerve that serves the pterygoid muscle, a branch of the mandibular nerve. These blocks are primarily done for relief of symptoms once it is clearly related to a problem in the distribution of the nerve, but if other methods have failed, this may be an option. If necessary, other blocks can be considered at different locations to identify whether the clicks are coming from the distribution of that nerve.
The other option to consider, if not already done, would be consideration of consultation at a major medical center with a strong national reputation, such as the Mayo Clinic. Doctors that these medical centers have more experience in the evaluation and management of unusual disease processes, and also may be developing new techniques or technology that is not available in most facilities but may be able to help in the diagnosis in your case.
If I can provide any clarification, please let me know.
Ask Your Own Neurology Question
Customer reply replied 2 years ago
Thank you dr love. The serial nerve blocks are a new idea. One thought was an emg of the ptyerigoid muscle. They have done an emg on the tongue and facial muscles. All came back normal. Believe it or not, i have seen dr. Barrs, dr bansburg both ents at mayo. I guess i need to go back to neurology.
One question, since this all started with the csf leak. Is there any chance this could be related to a low/high pressure and the sound is actually being caused by movement of the brain and/or other structures. Possibly cranial pockets being filled and/or empties. Another thought was that the eustachean tubes are reacting to low/high csf pressure against the inner ear. The tubes are opening and closing to attempt to regulate the pressure? Your thoughts are greatly appreciated.
Customer reply replied 2 years ago
None of the physicians, dr barrs, dr bansberg, dr halker/mayo headache specialist, dr slattery ent/house clinic los angeles, dr michael robb/otoneurologist phoenix, dr strategouleas/ ent tucson have ever seen anything like this. As you see my efforts of late have been ent related.
Customer reply replied 2 years ago
I mention the csf because the first test everyone has done to identify a leak was a tilt table. Very similar to what i am doing in video 1.
Neurologist: Dr. D. Love, Doctor replied 2 years ago
It would not be likely that this would be due to movement of the brain from altered fluid around the brain. I have never heard of this cause this type of sound. And the brain is a soft structure with no contractility, so would not have a clicking sound when striking a solid structure nor have any type of rhythmic phenomena that could generate sound in a rhythmic pattern. Muscles can spasm or have other abnormal contractions, such as the myoclonus that has been discussed, but there is no similar structure or action in the brain that can occur.
The Eustachian tubes can cause clicking, but if the clicks were due to the opening and closing of the Eustachian tubes, then that would usually be identified by the ENT doctor, assuming that it occurred or was reproducible in the office. In addition, the middle ear pressure that is regulated by the Eustachian tubes is not significantly affected by changes in CSF pressure. CSF pressure could theoretically affect the inner ear, but the Eustachian tube communicates with the middle ear.
Ask Your Own Neurology Question
Customer reply replied 2 years ago
Thank you for your insight. I have read some journals that indicate objective tinnitus due to csf but it is typically a pulsating sound/heartbeat. Onward i go.
Neurologist: Dr. D. Love, Doctor replied 2 years ago
It also is typically not audible if a video were made of the patient. It is due to pressure waves following the blood vessels that pass close to the inner ear.
Ask Your Own Neurology Question
Was this answer helpful?
Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love
Dr. D. Love, Doctor
Category: Neurology
Satisfied Customers: 19,551
19,551 Satisfied Customers
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.

Dr. D. Love is online now

A new question is answered every 9 seconds

How JustAnswer works:

  • Ask an ExpertExperts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional AnswerVia email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction GuaranteeRate the answer you receive.

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me.

Susan O.USA

Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help.

Mary C.Freshfield, Liverpool, UK

This expert is wonderful. They truly know what they are talking about, and they actually care about you. They really helped put my nerves at ease. Thank you so much!!!!

AlexLos Angeles, CA

Thank you for all your help. It is nice to know that this service is here for people like myself, who need answers fast and are not sure who to consult.

GPHesperia, CA

I couldn't be more satisfied! This is the site I will always come to when I need a second opinion.

JustinKernersville, NC

Just let me say that this encounter has been entirely professional and most helpful. I liked that I could ask additional questions and get answered in a very short turn around.

EstherWoodstock, NY

Thank you so much for taking your time and knowledge to support my concerns. Not only did you answer my questions, you even took it a step further with replying with more pertinent information I needed to know.

RobinElkton, Maryland

< Previous | Next >

Meet the Experts:

Dr. Mark

Dr. Mark

Neurologist (MD)

1,985 satisfied customers

Neurosurgeon - Brain, spine, and peripheral nerve surgery

Jack Scariano Jr

Jack Scariano Jr

Neurologist (MD)

1,056 satisfied customers

Board Certified Neurology 1982 30 years experince. Also expert in Pain Medicine

Dr. Bob

Dr. Bob

Neurologist (MD)

3,731 satisfied customers

Neurology & Int Medicine (US Trained): 20 yrs experience

healthydoc

healthydoc

Board Certified Physician

1,851 satisfied customers

Board Certified U.S. Neurologist

Dr. F

Dr. F

Board Certified MD

266 satisfied customers

Neurosurgeon with more than 20 years experience in practice and teaching.

Phytube.com

Phytube.com

Neurologist (MD)

86 satisfied customers

Pediatric Neurology and Developmental Medicine with Special Research In Pain Medicine/Medications

Stroke Doc

Stroke Doc

Board Certified Physician

51 satisfied customers

I am board-certified in Neurology and the subspecialty Vascular Neurology.

< Previous | Next >

Related Neurology Questions
I was diagnosed with neuropathy about 7 years ago and got a
I was diagnosed with neuropathy about 7 years ago and got a prescription for gabapentin but tried it about 3 times and didn't like the side effects as well as cymbalta. I started having trouble with t… read more
Dr. Nina Lim
Dr. Nina Lim
Doctor of Medicine
452 satisfied customers
I have had 2 strokes. i HAVE WEAKNESS IN MY RT ARM AND LEG.
I have had 2 strokes. i HAVE WEAKNESS IN MY RT ARM AND LEG. i HAVE TAKEN bOTOX INJECTIONS IN THE PAST NEAR MY WRIST AND THEY DID NOT HELP I BELIEVE THAT I HAVE HAD ADVERSE REACTIIONS TO THEM. SIX WEEK… read more
Dr.Saleem
Dr.Saleem
Consultant Cardiologist
Doctoral Degree
820 satisfied customers
I have nerve damage all around one shoulder.i have also lost
I have nerve damage all around one shoulder.i have also lost some strength in the arm. Is there anything I can do to relieve the pain and itch during the night? And rebuild the strength? I have a form… read more
DrJomab
DrJomab
Medical Doctor
47 satisfied customers
I have been diagnosed with peripherial neruopathy. I have
Hello.I have been diagnosed with peripherial neruopathy. I have seen a neurologist who has suggested a b complex supplement. I have also started to take 300mg gabapentin 3X/day. I have only dtarted th… read more
Dr. Nina Lim
Dr. Nina Lim
Doctor of Medicine
452 satisfied customers
My primary physician diagnosed me with preipheral neuropathy
Hi, My primary physician diagnosed me with preipheral neuropathy after I went to see her with tingling sensations in my hands, feet, and face a few months ago. She referred me to a neurologist for fur… read more
Dr. David
Dr. David
Radiation Oncology Attending Director
Post-Doctoral Degree
13,193 satisfied customers
I have severe nerve pain following a tummy tuck two years
I have severe nerve pain following a tummy tuck two years ago. Is there any vitamin to restore/help … read more
Dr. David
Dr. David
Radiation Oncology Attending Director
Post-Doctoral Degree
13,193 satisfied customers
I have recently diagnosed with frontal lobe dysfunction and
I have recently diagnosed with frontal lobe dysfunction and a hyperkinetic movement disorder. This doc told me I need to get off all my meds so he can help me. I was taking the following 2100 mgs Gaba… read more
Dr. Mark
Dr. Mark
Neurologist (MD)
Doctoral Degree
1,985 satisfied customers
Lower spine pain very severe into buttocks, no help with
Lower spine pain very severe into buttocks, no help with spine clinic injections, opiods help very little and only for 3 hours have bulging discs, scolorosis excuse spelling have diffibulator implant … read more
Dr.Saleem
Dr.Saleem
Consultant Cardiologist
Doctoral Degree
820 satisfied customers
Just diagnosed with shingles today. Very few outbreaks just
Just diagnosed with shingles today. Very few outbreaks just on my scalp and right eyebrow. But I have inteermittant (every 30 seconds) throbbing pain in my right temple. Prescribed acyclovir and gabap… read more
Neuro Doctor
Neuro Doctor
Full Time Neurologist
Neurologist MD (USA Board Certified
2,534 satisfied customers
I have severe pain in my legs. I think its something to do
I have severe pain in my legs. I think its something to do with nerves. Do I see a neurologist or orthopedist? … read more
Dr. Chip
Dr. Chip
M.D.
13,058 satisfied customers
Last week I went to a neurologist who diagnosed me with a
Last week I went to a neurologist who diagnosed me with a unique form of trigeminal neuralgia. However, another doctor thinks it is more of a problem with my tmj. I was put on gabapentin 75 mg twice a… read more
Dr. Muneeb Ali
Dr. Muneeb Ali
Senior Registrar Critical Care Medicine
Doctoral Degree
8,221 satisfied customers
I have a prickling sensation in my hands, is that normal?
I have a prickling sensation in my hands, is that normal? … read more
Dr. Mark
Dr. Mark
Neurologist (MD)
Doctoral Degree
1,985 satisfied customers
I am recovering from shingles and having sever attacks of
I am recovering from shingles and having sever attacks of herpes neuralgia.The attacks occur about 6-7 times a day lasting 45-60 seconds. … read more
Dr. Bob
Dr. Bob
Neurologist (MD)
Doctoral Degree
3,731 satisfied customers
I have neurophy in my feet and am taking gabapentin - I have
I have neurophy in my feet and am taking gabapentin - I have no problem during the day - but at night as soon as I go to bed- my feet get numb and ice cold. I have to stand up to get the feeling back … read more
Dr.Saleem
Dr.Saleem
Consultant Cardiologist
Doctoral Degree
820 satisfied customers
I am shaking all over and wonder if it is als. Gabapentin
I am shaking all over and wonder if it is als JA: Have you seen a doctor about this yet? What medications are you taking? Customer: yes gabapentin and Zoloft and clonipin JA: Anything else in your med… read more
Dr. Ravoof
Dr. Ravoof
Doctoral Degree
2,010 satisfied customers
What can I do for nevre pain besides gabapentin. The
No I took the I was taking gabapentin it helped but I can't get it tell the 10th and the pain is starting in the buttuck… read more
Dr. David
Dr. David
Radiation Oncology Attending Director
Post-Doctoral Degree
13,193 satisfied customers
Sick from gabapentin from day one.. violent nausea, tremors,
Sick from gabapentin from day one.. violent nausea, tremors, shivering, headaches. Titrated up very slowly to 300 mg three times a day. It took about a month. I was deathly sick the entire time and to… read more
Dr. David
Dr. David
Radiation Oncology Attending Director
Post-Doctoral Degree
13,193 satisfied customers
Severe ankle pain after emg cannot bear weight gabapentin
Severe ankle pain after emg cannot bear weight gabapentin 6x300 - tramadol at 37.5/325 - Advil 2x 200 as well as oxycodone and dilaudid no help. MRI shows l5-s1 problem. It my ankle hurts on lateral s… read more
Dr. Scott
Dr. Scott
Doctor
1,120 satisfied customers
Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Show MoreShow Less

Ask Your Question

x