Spontaneous Intracranial Hypotension and Hearing Issues - Neurology

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Suspected spontaneous intracranial hypotension headache causing hearing issues?


Hello Doctor, thank you for your response.
Background information: 1.
Normal weight, no hypertension.
I have never had headaches in my life.
2.
In 2016, I was hit from behind by a motorcycle.
There was a laceration on the left occipital area, but I was checked that day and did not have a concussion.
About six months ago, I slipped and hit the back of my head on the stairs; I did not seek medical attention, and aside from superficial pain, I had no other symptoms.
Symptoms experienced: I have never had headaches before, but about two weeks ago, while walking on a weekend evening, I suddenly experienced severe pain at the base of my skull (likely the occipital region) and in my neck, which was a pain I had never felt before.
However, lying down alleviated the pain, but upon standing, it felt as if my occipital area was under pressure.
Recognizing this was unusual, I went to a local urgent care the next day.
The nurse checked my temperature and blood pressure, which were normal, and ruled out meningitis.
I mentioned that I was in unbearable pain even while sitting and felt nauseous, and I also heard a whooshing sound in my ears, but the nurse suggested it was a muscle issue and offered to prescribe pain medication, sending me home.
I immediately vomited on the way home, and once I lay down, I felt better.
I researched online and found that spontaneous intracranial hypotension (SIH) headaches closely resembled my symptoms, so I took leave to rest at home.
I tried to lie down as much as possible, but I still went out for walks and to buy daily necessities.
I noticed that walking exacerbated the headache, and my ears felt like they were experiencing pressure imbalances, similar to the sensation when flying.
I endured this for about 12 days, drinking plenty of water, and the headache lessened, although I still felt pressure in the occipital and neck areas when driving or walking for extended periods.
However, starting from day 13, I noticed strange symptoms that have persisted for three days without any relief.
Now, whenever I sit, even doing nothing, or stand, my left ear feels blocked (similar to the sensation when flying), and I can hear my own breathing.
Lying down immediately relieves this sensation.
Even bending over also resolves the blockage immediately (opening my mouth or yawning does not help).
On the right side, every morning when I wake up, it sounds like I’m hearing through something or being muffled.
This is especially noticeable in the morning, and I feel like I can hardly hear out of my right ear.
The right side of my head and shoulder feels strange, and the right side of my neck is tighter.
However, after some activity by the afternoon, if I lie flat and relieve the blockage in my left ear, I still notice that my right hearing feels off; my own voice sounds different in my right ear (hard to describe).
I do not have a cold or any other symptoms, and I am unsure why this is happening.
I have consulted with local nurses, but the local examinations are too expensive.
I would like to ask if it is safe to plan for self-healing? I am just worried this could cause permanent damage to my hearing or brain.
I sincerely appreciate the doctor taking the time to read my description and help answer my questions.
Thank you.

Xiao Lin, 30~39 year old female. Ask Date: 2020/06/17

Dr. Jiang Junyi reply Neurology


Hello: Your symptoms indeed raise a high suspicion of intracranial hypotension headache.
The treatment for this condition primarily involves identifying the location of the cerebrospinal fluid leak and applying a blood patch to "seal the hole." Considering your relative difficulty in accessing medical care, it is recommended that you first consume caffeinated beverages, increase sodium intake in your diet, and wear a supportive abdominal binder to increase abdominal pressure.
Please observe if these measures can help improve your symptoms.
Wishing you good health and peace.
Dr.
Jiang from Taoyuan Medical Center is concerned about you.

Reply Date: 2020/06/17

More Info


Spontaneous Intracranial Hypotension (SIH) is a condition that arises from a decrease in cerebrospinal fluid (CSF) pressure, often leading to a range of symptoms, including severe headaches, neck pain, and auditory disturbances. Your description of sudden, severe pain at the back of your head and neck, which improves when lying down, aligns well with the classic presentation of SIH. The auditory symptoms you are experiencing, such as the sensation of ear fullness and altered hearing, can also be associated with this condition.

The mechanism behind SIH involves a leak of cerebrospinal fluid, which can occur due to various reasons, including trauma, as you mentioned in your history of motorcycle and stair-related accidents. Even if these incidents did not result in immediate symptoms, they could have caused micro-tears in the dura mater, leading to CSF leaks over time. The resulting low pressure can cause the brain to sag slightly, which may lead to tension on cranial nerves and other structures, potentially explaining your auditory symptoms.

Your experience of ear fullness, particularly when sitting or standing, is indicative of pressure changes in the middle ear, which can occur when CSF pressure is low. The Eustachian tube, which connects the middle ear to the nasopharynx, helps equalize pressure but may not function optimally under these conditions, leading to sensations similar to those experienced during altitude changes, such as on an airplane.

Regarding your concerns about self-healing and the potential for permanent damage, it is crucial to understand that while some cases of SIH can resolve spontaneously, others may require medical intervention. The risk of permanent damage, particularly to hearing or neurological function, increases if the condition persists without treatment. If you are experiencing significant symptoms, it is advisable to seek further evaluation, even if it involves higher costs. Diagnostic imaging, such as an MRI or CT myelography, can help identify the source of the CSF leak and guide treatment options.

In the meantime, there are some conservative measures you can take to alleviate your symptoms. Increasing your fluid intake, particularly with caffeinated beverages, can help raise CSF pressure temporarily. Additionally, maintaining a higher sodium intake may also assist in retaining fluid. Wearing a lumbar support belt can increase abdominal pressure, which may help alleviate some symptoms. However, these measures are not substitutes for professional medical evaluation and treatment.

If your symptoms worsen or if you experience new neurological signs, such as weakness, numbness, or changes in vision, it is essential to seek immediate medical attention. While it is understandable to be concerned about costs, prioritizing your health and well-being is crucial. Early intervention can significantly improve outcomes and reduce the risk of long-term complications associated with SIH.

In summary, while some individuals with SIH may experience spontaneous recovery, your symptoms warrant further investigation to prevent potential complications. It is advisable to consult with a healthcare provider who can offer a comprehensive evaluation and discuss appropriate treatment options tailored to your specific situation.

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