[36F] With severe neck pain, fluid seeping, and migraines

Patient Description

A 36-year-old female presents with severe neck pain, headaches, and swelling with clear fluid or white pus under the skin. The fluid moves with head movements, causing pressure and fluid-filled sacs all over the body. When the skin is cut or has any opening, the fluid seeps out. The fluid discharge is clear or white, sometimes thick, and comes out of the eyes, ears, and scalp. The patient experiences numbness in the left hand, described as pins and needles, tingling, and numbness, making it difficult to hold objects. This has been ongoing for a few months. The neck pain is constant, severe, worsens with any movement, and leads to migraines that worsen throughout the day. The migraines are described as severe pressure in the back of the head that spreads with movement, rated as a 10 on a scale of 1-10. The patient also experiences nausea and dizziness when the fluid moves in the head. Additional symptoms include chills, fatigue, general weakness, recent weight gain, night sweats, and decreased appetite. The patient has a history of spinal fusion surgery three years ago for bone spurs, a hysterectomy almost a year ago, Multiple Sclerosis (MS), and Raynaud's disease diagnosed two months ago. Current medications include Methocarbamol 300 mg three times a day, Lyrica 150 mg three times a day, Ritalin 10 mg four times a day, Subutex 300 mg injection once a month, and Suboxone half an 8 mg tablet as needed, along with ibuprofen for pain relief. There are no known allergies to medications and no side effects from current medications.

Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations for your condition:

1. Lymphatic Obstruction or Lymphedema

Rationale: The clear or white fluid seeping from your skin, along with swelling that moves with gravity, suggests a possible issue with your lymphatic system. Lymphedema can cause fluid buildup and swelling in various parts of the body.
Typical Treatments/Testing: Diagnosis may involve imaging tests like MRI, CT scans, or lymphoscintigraphy. Treatment often includes compression garments, physical therapy, and sometimes surgical interventions.

2. Infection or Abscess Formation

Rationale: The presence of pus-like fluid with an odor, along with swelling and tenderness, could indicate an underlying infection or abscess formation. This is especially concerning given your history of easily infected hangnails.
Typical Treatments/Testing: Blood tests, cultures, and imaging studies can help diagnose infections. Treatment typically involves antibiotics and sometimes drainage of abscesses.

3. Cerebrospinal Fluid (CSF) Leak

Rationale: The clear fluid seeping from your eyes, ears, and scalp, along with severe headaches and nausea, could indicate a CSF leak. This can occur due to trauma, surgery, or spontaneously.
Typical Treatments/Testing: Diagnosis may involve imaging studies like MRI or CT myelography. Treatment can range from bed rest and hydration to surgical repair.

4. Multiple Sclerosis (MS) Flare-Up

Rationale: Your history of MS, combined with symptoms like numbness, tingling, and severe headaches, could indicate an MS flare-up or progression.
Typical Treatments/Testing: Neurological examination, MRI, and possibly lumbar puncture. Treatment may involve corticosteroids, disease-modifying therapies, and symptomatic management.

5. Complications from Spinal Surgery

Rationale: Given your history of spinal fusion surgery, it's possible that some of your symptoms, particularly the neck pain and headaches, could be related to complications from the surgery.
Typical Treatments/Testing: Imaging studies like X-rays or MRI to assess the surgical site. Treatment may involve physical therapy, pain management, or further surgical intervention.

What you can do

Fluid Seeping and Swelling

See a doctor as soon as possible: Given the severity and unusual nature of your symptoms, it's crucial to seek medical attention promptly. Your doctor may need to perform imaging studies and other tests to determine the cause.
Keep the affected areas clean: To prevent infection, keep the areas where fluid is seeping clean and covered with sterile dressings.
Elevate the affected areas: When possible, elevate the swollen areas to help reduce swelling.

Neck Pain and Migraines

Consult a doctor: Your severe neck pain and migraines need medical evaluation, especially considering your history of spinal surgery. Your doctor may recommend imaging studies and possibly refer you to a specialist.
Pain management: Over-the-counter pain relievers like ibuprofen can help manage pain, but avoid exceeding the recommended dose. Applying ice packs to the neck may also provide some relief.
Physical therapy: Gentle neck exercises and physical therapy may help improve mobility and reduce pain.

Numbness and Tingling

Neurological evaluation: Given your history of MS, it's important to have a neurological evaluation to determine if your symptoms are related to an MS flare-up or another issue.
Symptom tracking: Use MDandMe to journal your symptoms, track progress, and share your notes with your healthcare provider.

General Symptoms (Fatigue, Chills, Night Sweats, Appetite Changes)

Medical evaluation: These symptoms could be related to an underlying infection, MS flare-up, or another condition. Your doctor may need to perform blood tests and other evaluations.
Stay hydrated and rest: Ensure you are drinking plenty of fluids and getting adequate rest to help your body recover.

What you should look out for

Given the severity and complexity of your symptoms, it's important to seek medical care as soon as possible. Reasons to seek care even more urgently include:

Fever or signs of infection: Such as increased redness, warmth, or pus from the affected areas.
Severe headache or changes in consciousness: These could indicate a serious underlying issue like a CSF leak or infection.
Difficulty breathing or chest pain: These could be signs of a more serious condition requiring immediate attention.
Worsening numbness or weakness: Especially if it spreads to other parts of your body.

Remember, while I can provide information and suggestions,