How to treat increased intracranial pressure?

Question

Hi doctor,

My wife has a history of TBI and grand mal seizures. A few months ago, she complained of feeling dizzy and "cabin pressure" in her head that bloomed into a full-on migraine. She does have a history of migraines, but these are so different. She gets confused, shutters, and seems physically unbalanced. Because of her past, after ruling out ear or sinus issues, her doctor has sent her to a neurologist. As a result, she has had this order and results:

1)Emergency visit, CT scan with no contrast (clean), Blood work (normal), UA (normal), Chest x-ray (normal).

2)EEG for 72 hours (for reasons unknown, they have not disclosed any results).

3)MRI and MRA (showing "predominance in the membrane wrapped around her brain. The one directly wrapped around or closest. Also, this test showed the damage to her skull and brain as a teen healed. "Unremarkable" was the term).

4)Blood work (showing no sign of disease, diabetes, or thyroid problems).

5)Spinal and lumbar test (the pressure was a bit high, but her doctor said that should not be a big problem. Also, results show no illness like MS, meningitis, or Lyme disease).

6) CT with contrast (results will not be known until her neurologist returns to the country.

Her last visit seemed hopeless. Her neurologist did not have any answers, did not feel like there was a significant concern anymore, and just upped her medication (Topamax). She currently has scheduled a visit with the ophthalmologist (because the pressure has caused "floaters") and a lymphoma doctor (to receive a cancer screening, mother has a history). Meanwhile, it just gets worse. After the test, she had almost two weeks of normal life, and now I want to fix her. Please also know she works around pre-emergent chemicals, pesticides, and herbicides and will undoubtedly be returning to work soon, well or not.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

Although every test was normal, CSF (cerebrospinal fluid) pressure of 28 is never considered normal, and most of her current symptoms can be explained based on increased intracranial pressure (ICT). The other point that strongly suggests improved ICT is the relief of symptoms following lumber puncture or lumbar tap for around two weeks. The cause of increased ICT ranges from mild trauma to brain tumors. I know that a CT report with contrast will be available after your neurologist returns. Still, I suggest you send CT (computed tomography) scan (both plain and contrast) to me after scanning with the scanner directly for interpretation. If you cannot get that scanner, please take a picture of each section separately, and then you can forward it to me.

Now, it would be best if she continued her Topamax (Topiramate) as prescribed and asked her to rest adequately.

I hope you find it helpful.

Thanks and regards.