Dear Dr. Roach: After many weeks of a unilateral nasal leakage of clear watery liquid, I was diagnosed with a cerebrospinal fluid leak. I experience almost constant leakage from the right nostril, which is irritating as well as embarrassing. After CT scans and an MRI, the source of the leak was found to be a small opening in the skull above the sinus. The next step is surgery, and the surgeon tells me I will need to be in the hospital for five to seven days. Is this something that is typical for this type of surgery? They also plan to inject a dye to check for the possibility of other openings. By the way, there has been no head trauma, and this seems to be a spontaneous leak. Any information you can give me would be greatly appreciated.
Dear A.C.: Cerebrospinal fluid leaks probably are unrecognized much of the time, and this leads to mistaken diagnoses and inappropriate treatments. The hallmark symptom is headache, which worsens upon standing and is better when reclining. Other symptoms may include neck pain, nausea, hearing loss and various other neurologic symptoms. Many people have a history of minor trauma, but not everyone. MRI usually makes the diagnosis, but it sounds like your surgeon has ordered a myelogram to confirm the MRI findings. This involves a CT scan with dye. As you suggest, some people have more than one source of leakage.
Many cases of CSF leakage can be treated with a “blood patch,” where your own blood is put into the spinal fluid. A clot can form at the leak, and over weeks, a scar may form that stops the leak for the long term. Unfortunately, many need several attempts, and the results are not always permanent.
I know very little about the surgery, and only your surgeon knows enough about your planned operation to comment on potential success rates and postoperative course.
Dear Dr. Roach: I would like to know if I can get shingles more than once. I had them in February, three weeks after a surgery. I am 75 years old.
Would it be a good idea to get the shot, now that I have had shingles? If so, how long should I wait before I get the shot? I do not want to experience it again, and the doctors don’t seem to be sure what I should do.
Dear B.H.: You can get shingles more than once; however, the likelihood is probably lower in people who have had it already. The Advisory Committee on Immunization Practices advises the shingles vaccine for those over age 60, even if there is a history of shingles in the past. The side effects of the vaccine are small, so even if there is less benefit, there may still be more benefit than harm. The vaccine can be given anytime after the rash has cleared up.
Email questions to ToYourGoodHealth@med.cornell.edu.