Neurologist urged for whiplash injury

DEAR DR. ROACH: My sister was rear-ended last summer and suffered whiplash.

She went to a chiropractor for adjustment, but that did not help.

She has experienced excruciating head pain ever since, whenever she bends over to do anything! If she lowers her head at all, the pain is so intense that her eyes water.

She’s gone to an ear, nose and throat doctor to check her sinuses (they were clear); for X-rays and MRIs; and to another chiropractor.

It’s been over five months with no relief or reason given for what’s happening to her. She gets relief within a few minutes when she lies down. ANSWER:: Tell her to see a neurologist.

I am concerned about a possible leak of cerebrospinal fluid, the fluid that surrounds and supports the brain.

In a serious whiplash-type injury, the lining of the brain can be damaged, and a small amount of CSF can drain out.

It is sometimes the case that the fluid is noticeable — most conspicuously as a runny nose — but it is at least as often that the leak goes unnoticed. This causes the pressure of fluid inside the skull to go down. The hallmark of low pressure inside the head is headache that is worse on standing or sitting. Most people will find that it gets worse with sneezing or coughing, but also with head movement.

Sometimes people will have lightheadedness or dizziness; nausea and vomiting; or neck pain and stiffness.

A brain MRI may make the diagnosis; however, the MRI is not always abnormal.

The diagnosis may be made definitively with a radioisotope cisternogram.

This involves a lumbar puncture (spinal tap) to measure the pressure in the fluid and to inject a radioactive dye, which then can be seen when it leaks out.

Treatment usually is first attempted with a blood patch (where the person’s own blood is placed into the CSF so the platelets in the blood can begin to close the defect), but surgery is sometimes necessary.

Please let me know how she does.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth @med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.