A not-so-brief introduction
 

Hello all,

Wish I didn't have to post here, but am sure glad I found this site. My story is as follows:

Exactly one month ago, I hit the top of my head very hard, in a moment of self-inflicted stupidity (I jumped up and hit my workout bar which was screwed into the door frame). The impact of the trauma went straight down my head into my neck and spine. I didn't black out, but my vision did go black for a second. Immediately after, I had all of the normal symptoms of a hard head knock: headache, pain on the head (no bump), etc. Later that day I was feeling better and decided to go jogging.

I later developed my most disturbing symptom either later that day or the next (can't remember): my ears were plugged, like I was in an airplane. They went away after that day, but reappeared a week later (maybe because I tried to return to working out?). Since then I've had good days and not so good days regarding the pressure in my ears. Sometimes it feels so heavy that I feel like I have tunnel vision and will pass out, other times I barely notice them. Along with the pressure is almost always fluid running down the back of my throat, which drains into my stomach/lungs as I sleep, giving me an awful cough, and suppressing my appetite. Oddly, the symptoms do subside greatly when I am laying down or sleeping.

My other symptoms include: intermittent headaches (hardly ever severe), a feeling of unsteadiness, but not full-blown vertigo - more like I'm less confident and agile on my feet. Also brain fog, noise sensitivity, restless sleep (always wake up before the alarm in a panic), difficulty concentrating, and difficulty focusing my eyes on objects, especially moving objects.

I had a CT scan done in the ER two weeks after my injury and it showed no bleeds. A week later I went to an ENT and he gave me antibiotics and a steroid nasal spray. Both the neurologist and the ENT seemed unconcerned.

I currently live in mainland China which is making things more difficult (I don't speak the language, and finding western specialists is not easy or cheap). I am a school teacher on contract, so taking time off from work is not a realistic option at this point. I have been watching my lifestyle choices though (no alcohol, MSG, caffeine, sugar or artificial sweeteners).

Anyway, thanks for reading my ramble... I'd really like to hear from others who share my symptoms (especially the ear pressure thing, as it is driving me nuts).

It does sound like it could be a sinus infection, on top of a head injury. When you hit your head, things swell up, making drainage of anything in the head more difficult. try alternating heat and ice, look up the vitamin thread here (it was bumped to the top recently), and remember to take it as easy as possible. I'm sure some of the more veteran member here will have more advice!

Balance Issues
 

When are you suppose to come back to your original country?You might want to look into a vestibular therapist for the balance issues etc.A vestibular therapist helps if you did knock your balance off.I wish the best to you.Acupuncture could help you possible while abroad.

I hadn't ruled out a sinus infection or allergies, but the fact that I have no other symptoms (ie, runny nose, itchy eyes, etc) makes me think otherwise. Plus, the symptoms appeared so close to my injury that I feel like it cannot be coincidence. If the symptoms persist I will attempt to get a scan of my sinuses to check, though.

This is not my first hard hit to the head, but it is the first that created symptoms that have lasted a while... the ones in the past I've shook off pretty easily. I've been on Google the past month self-diagnosing myself with everything and anything imaginable... :confused:

I'll be back in the US in July... so I'm still a few months off. When I do get back I'll be uninsured until I can find another teaching position, so my best bet may be to try and find care here. I am going to try to investigate acupuncture and therapeutic massage. When my headaches first appeared, I was able to control them with self-massaging my neck (many of my headaches radiated upwards from my neck).

If anyone has any advice on my symptoms, and what I should be asking for from a doctor if/when I go to visit I would appreciate it greatly. The past two times I've gone I've been brushed off (very frustrating), and I want to make sure I'm getting the proper scans and diagnostics done!

Have you been assessed for a CSF leak?

Count,

Is there an American compound anywhere near ? My cousin worked in China and lived in an American compound with full American services. His compound was for the petroleum industry.

The spinal fluid leak is a valid concern. You may also have injured your upper neck. Try icing your upper neck.

I suggest you plan ahead and arrange for health insurance to start upon your return. You should be able to apply for Blue Cross or something else online with overnight mail for signatures.

I was wondering abut CSF leak... but doesn't it usually manifest outwardly? I just figured that my sinuses were overproducing mucus in my ears from the trauma... However, I may mention the CSF issue when I do see another neurologist. It was a steady drain in the back of my throat, but now it is mostly only when I pop my ears that I feel some drainage. The pressure has waned a little (but still there often), but it has left me with a sense of heaviness and sensitivity in my ears when not feeling the pressure.

I can access a Chinese neuro. It is just the mental aspect of navigating the Chinese healthcare system which is overwhelming to me.

Mark, about the insurance... will they cover my doctor visits considering that it happened prior to getting the coverage? If so I can apply now and try to use it here in an expat hospital...

Thanks for all of the help and advice so far!

Obamacare has stopped the insurance companies from considering pre-existing conditions.

We had a poster here long ago (Vini) who had a CSF leak into his sinus. One way they fix them is clog them with the patient's blood so it clots.

I will definitely make sure to mention this when I see a neuro.

The new healthcare provisions sadly don't take effect until January 2014, according to the wiki. Anything from now till then will have to be out of pocket (thankfully I saved a lot here in China!).

I will be using this thread to update my progress. Thanks to all for the help and support. :)

Dear CountNomula,
Welcome, sorry to hear about yr predicament. To add to the above info, I do know that if you get the feeling that the floor will move away as you walk this is a concern to neurophysio's. You describe above the unsteadiness you now feel and a lack of confidence.
This can be a symptom of the neck spinal area becoming detatched. It is most common in rugby when a player suffers a head on collision. In your case a head up, but it's still the fact your neck took a full on blow.
What you need is an MRI looking at the soft tissue and tendens in your neck to see if they have shifted or are unstable.
Good luck.

CSF leak is very quick and easy to diagnose, it just takes getting a sample of the dripping fluid and test it for sugar -- a simple glucose monitor. Please try to have this done ASAP. CSF leak can be very dangerous for infection. Best wishes!!

Quick update:

I visited an ENT over the weekend. He listened to my symptoms and tentatively diagnosed me with a CSF leak. He told me to go to the big university hospital and speak with a neurologist, which I did. I am scheduled tonight to go and have an MRI of my head taken. They did not ask for a sample of my fluid (it is 99% post-nasal anyway, back of throat, so I doubt I could've produced some on demand).

I feel like I am making progress toward understanding what is happening to me. I am a bit worried that because my symptoms are lower today, the scan may miss something. HOWEVER, I want to make sure that:

a. I am getting the correct testing done
b. I am asking the right questions when I speak to a neuro about the scan

Can anyone with some experience chime in? Is an MRI sufficient to show a CSF leak? Even if there is no 'brain sagging'? And what sort of things should I be asking the neuro when we discuss the results?

A CSF leak does not always show up on an MRI. The best test is the beta-2 transferrin, if you can get a fluid sample. Those who have a CSF leak sometimes experience fluid dripping out of their nose when they lean forward, and can obtain a sample this way. The sample is time sensitive, and is only good for about 4 hrs. at room temperature, or 3 days if refrigerated. Other tests may include a CT with contrast dye, or a pledget test. Also, you can try increasing your caffeine intake to see if this temporarily helps to alleviate some of your symptoms. Although caffeine is contraindicated in those with PCS, it is recommended for individuals with a CSF leak as it helps to increase the volume of cerebrospinal fluid.

This is what worries me... I had my MRI taken last night, but I'm afraid they'll gloss it over and say 'nothing to worry about'. I'm not even going to see the same neurologist tomorrow for my results as the one that ordered the scan. The scan was done without an injection and took about 10 minutes total... I'm guessing this isn't anything too powerful, considering its a public Chinese hospital...

My head is officially spinning...

Got my MRI results back - clear! Or so I thought...

I consulted a neurosurgeon with my scan. He said that he saw no abnormalities. He also said that he believes I have a small skull fracture, contributing to CSF leak... huh?!

I asked why it isn't on the MRI, and he said they aren't always visible on them, and that he needs to do further scanning and a lumbar puncture in order to be sure.

I am about to go in tomorrow and get these tests done...:eek:

It sounds like you are getting a thorough assessment done. I have some symptoms similar to yours, but have not been evaluated for a CSF leak. After my car accident, my CT showed that there was fluid in the sinus cavity. It was attributed to sinusitis, which I have never had before. I had fluid leaking out of my left nostril. This stopped after a few months, but I still have congested sinuses, and can feel fluid dripping down the back of my throat. I also have issues with my left ear. It feels like there is fluid in the eustachian tube as well, and I have constant pain in that ear. Hope you determine what your problem is, and that you get better soon. Good luck with your tests.

I got my final evaluation. All in all, I saw three separate neurosurgeons (including the head professor at the teaching hospital) who looked at my MRIs. All three had the same conclusion - no leak. I feel both relieved and upset. I'm relieved that I do not have something so debilitating. However, I also feel upset, because now I feel like I am stumbling in the dark, trying to put a name to my symptoms.

I re-visited the ENT today who originally suspected CSF leak to discuss the results. He seems to want to chase the CSF leak diagnosis even though three neuros said no. When I countered that it could be a sinus infection, he said that he saw no signs of inflammation of mucus buildup from the MRIs. I am to return for a sinus CT and possible camera roto-rooter up my nose at the ENT hospital here to see if there's a sinus issue, but I am fearful that will come back clean, and then I will truly have no answers... :(

Sounds like you have a brain injury. I guess that can cause so many different problems. Healing thoughts to you.

Hi,

I am confused here:

The symptoms subside greatly when lying down or sleeping.

However, does the drainage occur most at this time? or - Is the drainage occurring more during times before then and then subside after you lie down??

I ask because of my next few questions.

Was a Radionuclide Cisternogram done - a mainstay for CSF Leak evaluations.

--What is a Radionuclide Cisternogram ?

Was any CT testing done, with or without contrast? - again more useful for CSF leak evaluations per studies.

I know you are in a foreign land, and won't be back in the U.S. until July - hopefully you will have all films in hand and get follow-up at home for comfirmation when you get home.


Sitting up with symptom increases could reflect the csf leaking increases which slow to stop when reclining, which are reflected by your symptoms subsiding when you lie down.

Best Wishes........... :grouphug:

Quick update... so far I've seen 3 neurosurgeons and 2 ENTs regarding potential CSF leak. They are all in agreement that there is none presently, or if there is one, that it is so small that it shouldn't be causing my ear issues.

I feel as if my 'classic' concussion symptoms are largely subsiding. I can read, concentrate, go outside and places with lots of sensory stimulation, and my headaches are very mild. For this, I am very thankful.

However... my ears remain plugged. It is not a 24/7 thing. They flare up and subside. They can go from 0 to 10 in a few seconds. Popping will open them up, but they close back up. Basically they don't go away until they are ready to. I believe they flare during physical activity, talking, eating, etc the most. I am not a stressed or anxious person usually, so I feel like that isn't a contributing factor.

I plan on visiting a chiro in the near future. I doubt if there are UCC's here in China, but there are well respected general chiros in my city that I can visit.

Ear Pressure
 

Hi,

I too have a noticeable ear pressure thing going on - I did not mention it to my Dr. as I was not sure if there was a connection - Probably won't mention it either as she has not been any help with my concussion.

Curious if there is a connection???