From: To: Jeffrey Epstein <[email protected]> Subject: Re: melanie has sent you an UpToDate topic Date: Sat, 09 Mar 2013 05:02:36 +0000 I wonder if she has has an underlying connective tissue disease See references 20 and 21 Worth checking On Mar 8, 2013, at 6:55 PM, Jeffrey Epstein [email protected]> wrote: great On Fri, Mar 8, 2013 at 6:43 PM, melanie < wrote: JEE - read through this article. It is the most comprehensive that I could find related to low CSF pressure headaches. Perhaps there is something in here that will resonate, or at least it will tell us that this ISN'T what she's got. ©2013 UpToDate e Official Topic from UpToDate®, the clinical information service on the web and mobile devices. To subscribe to UpToDate®, visit us online at http://www.uptodate.com/store. Pathophysiology, clinical features, and diagnosis of spontaneous low cerebrospinal fluid pressure headache Authors Christina Sun-Edelstein, MD Christine L Lay, MD, FRCPC Section Editor Jerry W Swanson, MD Deputy Editor John F Dashe, MD, PhD All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Feb 2013. | This topic last updated: Jan 17, 2013. INTRODUCTION AND TERMINOLOGY — The production, absorption, and flow of cerebrospinal fluid (CSF) play key roles in the dynamics of intracranial pressure. Alterations in CSF pressure can lead to neurologic symptoms, the most common being headache. Most often, the headaches associated with low CSF pressure are orthostatic and occur after lumbar puncture, but similar headaches occur with spontaneous low CSF pressure due to spinal CSF leaks and with CSF shunt overdrainage. In addition, trauma, surgery, and other medical conditions have also been associated with low CSF pressure headache [1]. Spontaneous low CSF pressure headache is being recognized with increasing frequency. Orthostatic headache, low CSF pressure, and diffuse meningeal