Current Research and Scholarly Interests
Cerebrospinal fluid (CSF) leaks are a treatable disease that can cause a myriad of symptoms including chronic head pain, headache, migraine, neck pain, nausea, vomiting, ringing in the ears (tinnitus), difficulty concentrating, difficulty with memory, and fatigue. One of the cardinal features of cerebrospinal fluid leaks is that symptoms tend to be worse depending on the posture of the body-with headaches being more prominent when upright, and relieved when lying down (orthostatic headaches). Among people who are leaking chronically, a person may need to be upright or flat for a protracted period of time in order for symptoms to be exacerbated or relieved. Therefore, many patients with cerebrospinal fluid leaks experience a typical daily pattern in which the mornings are better-especially before arising from bed, but things get progressively worse as the day goes on with prolonged upright activity.
Because patients with cerebrospinal fluid leaks often feel significantly worse when they are upright, patients with cerebrospinal fluid leaks may be misdiagnosed with an alternative diagnosis associated with increased symptoms depending on body posture such as postural orthostatic tachycardia syndrome (POTS). In addition because of reduced spinal fluid pressure the brain may sag resulting in a misdiagnosis of Chiari malformation. Other patients have been diagnosed with New Daily persistent Headache (NDPH), Chronic migraine, Occipital Neuralgia,and Chronic Fatigue Syndrome.
Cerebrospinal fluid leaks should be considered as a diagnostic possibility in any patient who has previously undergone an injection into the spine, or the placement of a needle into the spinal fluid and is then experiencing symptoms that are worse when the patient is upright and relieved when the patient is flat. In addition, it is well recognized that spine surgery can precipitate cerebrospinal fluid leaks related to the surgery.
CSF leaks are understood to be much more frequent among people with genes that make their connective tissue less strong. These patients may be notably flexible, unusually tall or unusually short, may appear to be double-jointed, or have unusually stretchy skin. Clinically, these patients often have multiple joint dislocations, or joint sprains at different times of their life, may have early arthritis in multiple joints, and may have multilevel spine pain from degenerative joint disease or degenerative disc disease. Subsequently many patients have been misdiagnosed as having fibromyalgia, chronic fatigue syndrome, and other conditions. Some hereditary disorders of connective tissue are named such as Marfan syndrome, or Ehlers-Danlos syndrome (EDS), but other people may have a number of signs and symptoms associated with hereditary disorders of connective tissue, and are more likely to experience spinal fluid leaks, but don't have these named syndromes.
Dr. Carroll's current clinical and research work are oriented towards ensuring that all patients with cerebrospinal fluid leaks receive prompt diagnosis and effective treatment.
Patients and physicians may find the following lecture on cerebrospinal fluid leaks helpful and informative:
https://www.youtube.com/watch?v=QyvWxobqKrc
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