mikessr

[mikessr]

A Family member needs advice badly.  She is 35 years old, mother of two children ages 5 and 9.  She has never been seriously ill and has never suffered a physical trauma of any significance.  She has always been a  hard charger, always on the go, and always with a smile on her face.  Several months ago she started somewhat suddenly with daily, debilitating headaches.  She characterized he headaches as:  every day; less severe in the morning but worsening to sometimes excruciating pain in the evening (she has spend many evenings in bed the past few months); pain is intense at the TOP of her head - she has sensitive spot on top of her head; it feels like her head is WET at the top when it is not wet at all.  Numerous tests - blood tests, MRI,spinal tap, and many more - show no problem.  She has two excellent physicians trying to solve this mystery.  They have tried pain relievers, anti-biotics, steroids, botox injection, and other treatments.  She reports that the steroid treatment seemed to give her relief for a day or so.  Otherwise, she has experienced no improvement for months.  Can anyone help with advice?

[mikessr]

The sufferor had a spinal tap that did not readily heal.  Her spinal fluid was leadking out. She had a "blood patch" injected.  However, the pain was so unbearable that she was found in the fetal position yesterday.  After all this, the lubar tap results showed no abnormalities.  New step is the patient will be visiting a noted neurologist this Friday for assessment.  We understand that this physicisian is one of the best in America.  I was wondering if there were particularly successful clinics in Florida that specialize in head pain?  Can you recommend one?  If so, it may be worth taking here there for analysis.  She has been in significant to excruciating levels of pain now for almost 4 months and through dozens of tests..and we still do not have a clue.  Any thoughts would be most apprecated.  Thank you very much for your concern and valuable insights.

[Vanessa Lacuesta]

Hi,

This does sound like a baffling neurologic case.The symptoms of a severe headache associated with a sensation of wetness on top of the head may be nerve related given normal findings in all examinations.This sensation of "wetness" has to be elaborated.A complete mental status examination may also be extracted. Vascular insufficiencies also have to be excluded.Were any duplex scans done in blood vessels ( carotids for instance?).An assessment of heart function done as well as serum electrolytes
( Calcium, sodium, potassium), Vi B6 levels?Ophthalmologic consult may also help determine any underlying eye involvement.

The lumbar tap may be able to tell us something.The key may be is to be as thorough as possible. Medical history is important including a complete travel, occupational,menstrual and sexual history.

Do keep us posted regarding her progress.

[mikessr]

Dr. Laquesta,

Thank you vrey much for the reply.  Her head pain situation has worsened as she had a spinal tap to identify possible causes of her current headaches and her spinal fluid is leaking out.  That situation is being taken care of at the hospital by a "blood patch", but she is in extreme pain as of today.  

One non-medical person suggested trying a chiropractor also in the event this is a pinched nerve.  Does that make sense?  

Following are specific answers to your questions.  

The headaches appeared suddenly? YES

Were there any significant events or circumstances surrounding the onset? ( eg trauma, vigorous exercise, high level of stress at work or at home?) NO

Any underlying conditions like hypertension, diabetes, vascular insufficiencies? NO

Any lesions on the skin or scalp? NO

Any associated fever, vomiting, dizziness, numbness, and other neurologic deficits NO FEVER, SOME NAUSEA AND DIZZINESS, SHE HAS A SENSITIVE AREA ON TOP OF HER HEAD THAT "FEELS WET" WHEN IT IS NOT.

Does the pain keep her from doing her daily activities? ABSOLUTELY YES.  SHE HAS BEEN FORCED TO SPEND A SIGNIFICANT TIME IN BED, PARTICULARLY AS HER HEAD PAIN INCREASES LATE AFTERNOON/EARLY EVENING.

The MRI and the lumbar tap did not show anything. ALL TEST RESULTS RECEIVED TO DATE ARE NEGATIVE, BUT THE RESULTS OF THE LUMBAR TAP ARE NOT IN YET.



Has any of the physicians discussed with you a probable diagnosis?  PINCHED NERVE IN THE NECK IS BEING INVESTIGATED BUT THIS IS REALLY A MYSTERY DISEASE AT THIS TIME.



Any ophthalmologic examination done?  NO

THANK YOU AGAIN VERY MUCH.  ANY IDEAS ARE GREATLY APPRECIATED.  THE TWO FINE PRIMARY PHYSICIANS (ONE MD SPECIALIZING IN SPORTS MEDICINE AND ONE A PLASTIC SURGEON SPECIALIZING IN HEAD TRAUMA) ARE RECEPTIVE TO ANY IDEAS.  

Mikessr

[Vanessa Lacuesta]

Hi,

The headaches appeared suddenly?

Were there any significant events or circumstances surrounding the onset? ( eg trauma, vigorous exercise, high level of stress at work or at home?)

Any underlying conditions like hypertension, diabetes, vascular insufficiencies?

Any lesions on the skin or scalp?

Any associated fever, vomiting, dizziness, numbness,and other neurologic deficits ?

Does the pain keep her from doing her daily activities?

The MRI and the lumbar tap did not show anything.Has any of the physicians discussed with you a probable diagnosis?Any ophthalmologic examination done?

Do keep us posted with your answers.