Interventional Radiologist Questions

Tailbone pain Worsening post-blood patch

I've had a chronic CSF leak 2/2 HEDS/JHS for 4y. 9d ago I had a blood patch under propofol by an IR. I laid flat for 3d and over this time I had severe frontal/periorbital headaches while lying down - I began acetazolamide POD3 for RIH but the headaches worsened and when I was able to stand, I found laying down actually made them more bearable - stopped the acetazolamide after 12h of use. Headaches have lessened in severity since then.

However, before the patch, I used to get a huge rush of pressure when I would stand up followed by a severe throbbing headache, pulsatile tinnitus/whooshing sound, and blurred vision. NOW those symptoms have lessened significantly, but I am having that same build up of pressure and pulsatile pain in my tailbone and lower spine. The pain itself feel kind of cold (like when you touch something so hot it feels cold) or like someone has stabbed my bone with a knife and it radiates into my legs which hurt and feel numb/weak (although I don't experience physical weakness), After standing for a minute it goes away but it cam return if I squat and then stand up. This has successively gotten worse each day since it began.

My lower back around the spine is very sore and stiff and I'm struggling to walk or move position in bed without some pain. There is no tenderness to palpation, warmth, or erythema. I have had no fever or systemic symptoms. Otherwise I am a relatively healthy 25F with a normal BMI and BP.

Unsure what any of this means. i am a 4th year medical student and this is the first time my symptoms have truly stumped me.

Female | 25 years old
Complaint duration: 8 days
Medications: Adderall IR, Modafanil, Duloxetine, Ajovy, Metoprolol, Ibuprofen/Tylenol PRN
Conditions: Joint Hypermobility Syndrome/Hypermobility Ehlers Danlos, Chronic CSF Leak, Narcolepsy, POTS

1 Answer

I am sorry I do not have a lot of experience with blood patch placement in the subsequent complications or failures of the technique. However, if you are still having these type of symptoms after the blood patch, you need to go back to the interventionalist that did the procedure and let them know immediately as you may be leaking CSF and that could be giving you the headaches and lower back pain. Best I can tell you at this time. It is all I know. Please contact the IR physician that did the blood patch and let them know.