SEVERE HEADACH., LUMBAR PUNCTURE,

[Jim to Terri]

My husband, jim, woke up on the 26th with severe headach.  I gave him 2 T-3's and a tylox that didn't help. Took him to the hospital, his blood pressure was about 210/160.  They gave him demerol which helped ease the pain.  A CT was done, only thing of note was a small area near the thalamus which they thought could have been an old stoke.  An intern did a LP while my husband was draped over the bed table. I, not the "DR", told Jim to lie down. They are still baffled by Jim's erratic blood pressure. They are unable to stabilize the BP for long though they have given him numerous kinds of medications: done an MRI, inconclusive: the fluids taken from the spine, neg: blood work, neg; Urinalysis, neg. He has since developed NECK pain assoc with the LP that is different than the headaches. From all that I have read so far no one mentions neck pain assoc w/ LP only headachs. Now they want to do a blood patch. The other night I was told they max'd out the amout of pain killers they could give him for the headaches. They Drs are baffled as to the cause of the pain/high BP, It's like what came first the chicken or the egg. Any sugestions?

[CCF-Neuro-M.D.-CS]

Regarding the initial headache, it is possible that the headache was the result of the blood pressure, or vice versa. However, his blood pressure has remained elevated despite treatment which concerns me. Therefore, until the BP is controlled we can not differentiate what is causing the headache. The MRI helps to exclude vascular malformations, strokes, and masses. The LP helps to exclude infection and a subarachnoid brain hemorrhage. You should ask the doctors if they evlauated the veins in the brain for clots. If the veins are blocked this can cause severe headaches. This can be evaluated with a MRI.

Regarding the post LP neck pain, if the pain is high in the neck it could be the result of a spinal leak. If this is the case then blood patch would be reasonable. It is true that most spinal leaks cause head pain, but the back of the head and neck can also be involved.

If you still do not find a casue then ask for a second opinion, and if he is admitted to the hospital you can ask to be transfered to a larger academic center for an opinion. Good luck.

[snowgoer]

Hi, just wanted to add that I have to agree with Cat9. My father had severe hypertension caused by blockage to his renal artery. By the time it was realized the cause of it, he ended up having his kidney removed. This helped with the blood pressure problems, but led to others. Please be sure that a renal arteriogram is performed if all other causes (including adrenal tumors) are ruled out.

[mls2go]

Agree with Cat and Snow as well.  Adrenals are placed right above the kidneys and need to be monitored as well.

My mother has hypertension and (lucky me) it runs in the women in our family.  Question:  Did the doctors check his carotid (sp?) arteries as well just as a precautionary measure?  High Blood pressure and hypertension can cause blockages in these arteries as well and often a simple sonogram can rule out any problems.
Just a suggestion since he is certainly a high risk patient for this kind of problem and from what I read from your first post, it doesn't look like they've even considered this.  

My mother had carotid artery surgery two years ago and it started out with neck pain and severe headaches.  I'm not saying your husband has the same thing, but it might be a good idea to have this check ASAP.

[Cat9]

First of all I am not a doctor..just someone who remembers reading something once.. I remember reading that sometimes high blood pressure is caused by a blockage in the kidneys. This may have nothing to do with what is going on with your husband.. I'm just throwing out my 2 cents worth in case it helps.Good luck and I hope everything works out.

[Cat9]

Its me again. Here's a link to a site that talks about high BP and renal artery blockage. It looks like they could do an ultrasound to check it out. Again, hope this helps.
http://www.icorp.net/cardio/articles/renal.htm