Dr. Rahul Pramod Patil
Neurosurgery
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Patient's Query
Can someone interpret the two please? I am having pressure and metallic drainage after the second image could this be a CSF (Cerebrospinal fluid) leak? Also why does my pituitary look lifted/ detached? One is taken before a month and it shows my pituitary enlarged but looking intact, before I had a blood patch done. The other is from this month 2 weeks after having a blood patch and it looks like my pituitary is lifted. I winded up having pressure building up in my head and had fluid draining down my throat and still do, however none of my physicians can detect the difference.
Hi, Sorry for the pain you are going through.
To find out CSF leak, investigation in cases like you is CT-cisternogram. ( spontaneous CSF leak has been reported in patients). You can sit in forward stupping ( bending forward) position, collect some fluid and send it for beta-transferin test ( specific test) for CSF (Cerebrospinal Fluid). Blood patch does not cause pituitary to get enlarged or displaced. Your pituitary gland appears to be displaced and enlarged, this could be due to physiological changes happening in female, to rule out any pathology get pituitary hormone study ( prolactin, TSH, GH, ) in raised then do a MRI BRAIN (P+C) (pituitary protocol). If CSF study and CT are negative then you can do lumbar puncture ( under all precautions) and look for opening CSF pressure and see if drainage of CSF (Cerebrospinal Fluid) give you relief from your headache. ( however there is no proper indication of doing this in your case).
Patient's Query
Hello, so the two pictures where my pituitary looks intact, one is actually done before four years in which it wasn't enlarged, and the other is taken before a month where it was but still in place, so you're saying the two where it looks displaced, could indicate opening pressure? As in from a CSF (Cerebrospinal Fluid) leak or as in increased intracranial pressure? And can a CSF leak cause opening pressure? I ask because I also have a CT (Computed Tomography) with contrast report that stated fluid found in my right sphenoid sinus however I do know my pituitary sits above the sphenoid and I believe that is the source of where my fluid is coming from, also since I've had this both of my eyes have sunken and feels like they're wedged back into my head. However it appears I also don't have a brain sag. I also have chiari 1 malformation. Could it be possible that any ICP could cause build up and result in a tear through the sphenpid especially with an enlarged pituitary? Thank you
Opening pressure is measured during lumbar puncture and not on CT (Computed Tomography) or MRI (Magnetic Resonance Imaging). CSF (Cerebrospinal Fluid) pressure have no effect on eyes (bulging or shrunken ). It affects retina of eyes and finally vision. You get a CT cisternogram, which will help us to have a clear picture.( CT contrast is not helpful). If you have chiari-1 malformation, then lumbar puncture is contraindicated. You have chiari-1 malformation, then CT cisternogram is also contraindicated. Do a MRI SCAN and look for any site of CSF collection. But first do CSF study ( beta-2 transferrin) test to confirm CSF leak
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Neurosurgery
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