intracranial hypotension syndrome?

10:08pm. the paper i am holding in the previous entry's photo is Paldino, Mogilner, and Tenner (2003): Intracranial hypotension syndrome: a comprehensive review, from Neurosurgical Focus. they state, lest you be concerned, “Intracranial hypotension generally is considered to be a benign condition, and most cases resolve with conservative management."

when bronwyn met her medical consultant this afternoon, with a trail of about eight registrars and junior doctors, they gave her results on the lumbar puncture: they found elevated protein and some white cells in the CSF, but they hadn't found (in his words) “a bug” yet... no sign of bacteria, no sign of a virus yet... tests continue on the sample.

when he asked if we had any questions, bronwyn did not, but i did. i told him i'd been reflecting on the observation of the registrar that bronwyn's CSF pressure had been unusually low when they did the lumbar puncture. this had led me to think about bronwyn's other symptoms, including the fact that consistently from the outset her symptoms have acutely worsened with an upright posture, and significantly resolved as soon as she lies down, as well as some other symptoms. i (of course) noted it wasn't my field—i'm a clinical neuropsychologist, not a physician or neurologist—but said i'd been doing some reading overnight, and asked if he thought it was possible bronwyn might be suffering from intracranial hypotension syndrome? (this is a condition where the cerebrospinal fluid, the shock-absorber that supports your brain, is not doing its job correctly because it is not under sufficient pressure, basically because there is not enough of it.)

the consultant reported that the primary hypothesis was still viral meningitis, but (i think on the strength of our discussion) he has now ordered an MRI scan of her brain to provide further information. bronwyn is getting good followup. my guess is bronwyn will be in hospital for perhaps up to a week even at this point. as far as i can ascertain, management of both viral meningitis and IHS is frequently the same: pain relief, fluids, rest until you are better. however, unless a crystal-clear diagnosis is made my bet is the doctors will probably now prefer to keep an eye on her directly.