[Wouter Schievink, MD] My name is Wouter Schievink.
I’m a neurosurgeon at Cedars-Sinai Medical Center.
I remember quite well when I became interested in cerebrospinal fluid leaks.
It was about 1991 and I was working at the Mayo Clinic in Jacksonville, Florida
We had a patient, in her twenties, who had been complaining of unbearable headaches.
A leak was identified. We took her to the operating room the next day.
We were able to fix her leak and she was cured. The most common symptom, I would say, would
be more than 95% of our patients that we see do present with a headache. Of
course, headaches are very, very common, but this is usually described as a uniquely
different type of headache. It’s described as a very positional headache.
[Connie Deline, MD] My name is Connie Deline. I am a patient with spinal CSF leak
and I’m also a physician. My first symptoms were severe headache,
nausea, vomiting, and pain between my shoulder blades.
What I noticed pretty quickly about the headache was that if I laid down,
it improved quite considerably. It didn’t go away but it improved a lot. If
I raise my head up again then it got much, much worse.
[Wouter Schievink, MD] The reason why these headaches are usually so much worse
when the person is upright is that the brain floats on spinal fluid. If you’re
leaking spinal fluid in the spine, the brain sort of gets sucked down towards
the spinal canal. That causes a lot of traction on structures of the brain
that are very sensitive to pain. [Connie Deline, MD] The headache was escalated
over the course of 20-30 minutes and was located at the back of my head at the
base of the skull. So, it was clearly a very positional headache. I hadn’t
ever experienced headaches before. So this was new and it was pretty obvious
to me that this was something significant. [Wouter Schievink, MD] Unfortunately, we know
very little about how common these leaks in the spine are. We really only
diagnosed patients who have significant symptoms from that and I think there probably are many,
many patients who go undiagnosed.