A Houston woman thought she had dementia. Then a doctor saw something new in a scan of her brain.
Debra Roberts in Spring on Wednesday, July 30, 2025. A Houston woman spent years believing she had early-onset dementia before a Houston Methodist doctor found the true cause, a spinal fluid leak. Now they're pioneering a minimally-invasive surgery to fix those leaks. (Elizabeth Conley/Houston Chronicle)
Four years ago, Debra Roberts' headaches and memory loss had become so severe that she could barely remember her son's wedding.
The 62-year-old Spring resident spent years suffering from symptoms that doctors could not explain. An MRI of her brain, taken in 2018, provided no clues. Doctors became so convinced she had early-onset dementia that they told her to prepare to move into a nursing home.
"I had no sense of anything at all," she said.
Roberts was desperate by the time she asked Houston neuroradiologist Dr. David Badger to look at another MRI of her brain in 2020.
He spotted something that had been imperceptible on the earlier medical imaging – and it offered hope that Roberts could recover.
A rare medical condition
Houston Methodist doctors determined that Roberts had a spontaneous cerebrospinal fluid leak, a rare condition that can cause symptoms that mimic dementia. Her story is an example of how a treatable condition can be misdiagnosed, leading to years of frustration for patients.
Roberts' case led the hospital to become a pioneer for a minimally-invasive procedure that can alleviate CSF leak symptoms.
Roberts was the first Houston Methodist patient to be treated with the procedure, and patients from across Texas and nearby states are now flocking to the hospital's fledgling CSF leak program for treatment. Doctors at the hospital also believe the minimally-invasive approach is the future in treating CSF leaks, and can help raise awareness of the condition.
However, Houston Methodist doctors first need to find the leaks in patients like Roberts. Leaks are typically a few millimeters in size, small enough that they can't be seen on a normal X-ray, said Badger, a neuroradiologist at Houston Radiology Associated, which provides radiology services at Houston Methodist.
"That's the harder part," Badger said.
Dr. Kurt Yaeger looks at scans of Debra Roberts' brain showing cerebrospinal fluid leak that caused brain sag at Houston Methodist Hospital in Houston, Monday, July 14, 2025. Yeager and doctors at Methodist are pioneering a minimally-invasive surgery to fix spinal fluid leaks that have caused brain sag. (Brett Coomer/Houston Chronicle)
Years of frustration
Roberts knew something was wrong after she woke up one day in 2017 and was suddenly having severe headaches and trouble walking.
She spent the next three years seeing various doctors, searching for a diagnosis that never came. Neurological evaluations, an MRI, and CT scans didn't provide any answers, even as she developed additional symptoms like dizziness, tinnitus and trouble sleeping.
By 2020, she began having trouble with her memory. She was forced to take a leave of absence from her job at Houston Methodist – The Woodlands, where she worked as a technician in the catheterization laboratory, because she didn't trust herself around patients.
Doctors believed early-onset dementia or Alzheimer's disease was causing Roberts' symptoms. Her husband, Rick Roberts, refused to accept the diagnosis.
"But it was pretty worrisome," he said. "It was very obvious that there was something that was out of whack."
Dr. Kurt Yaeger, left, and Dr. Sanjeev Sreenivasan perform an endovascular embolization surgery to treat a patient's cerebrospinal fluid leak at Houston Methodist Hospital in Houston, Monday, July 14, 2025. Yeager and doctors at Methodist are pioneering a minimally-invasive surgery to fix spinal fluid leaks that have caused brain sag. (Brett Coomer/Houston Chronicle)
Finding an answer
Rick Roberts scoured the internet for an explanation and eventually found the possibility of a CSF leak. Cerebrospinal fluid surrounds and protects the brain and spinal cord, and plays a vital role in brain function. Leaks are typically caused by injuries or trauma, but in rare cases can occur spontaneously.
Such leaks are rare, affecting about 1 in 20,000 people per year in the U.S., according to The Spinal CSF Leak Foundation.
Roberts asked Badger to review her second MRI, taken in 2020. The imaging showed clear signs of "brain sag," a condition where the brain begins to "sag" into the top of the spinal cord because there's not enough cerebrospinal fluid to prop it up and hold it in place.
The brain sag was virtually imperceptible in the MRI taken three years earlier, so it's likely that Roberts' condition worsened to the point it could be seen, Badger said.
"In her case, [the brain sag] was very apparent," he said. "I think that's why she had such severe cognitive symptoms."
It's unclear what caused Roberts' leak, but patients are sometimes predisposed to them if they have underlying connective tissue disorders, her doctors said.
Regardless, Roberts and her family were ecstatic to finally have an answer.
"We were so excited, because I was going to get my life back," she said.
Pinpointing the problem
The imaging confirmed Roberts had a CSF leak, but doctors still needed to find it.
Badger injected contrast dye into Roberts' spinal canal, then used medical imaging to see how it flowed through her body. The technique, called a dynamic myelogram, helps to visualize the spinal cord and nearby nerves and soft tissue, and pinpoint the location of a leak.
The myelogram revealed a leak on the right side of Roberts' thoracic spine, near the midpoint of her back.
The Houston Methodist team initially tried to fix Roberts' leak with an epidural blood patch, which involved injecting her own blood into the area around the spinal cord to seal it.
But Roberts had a type of leak known as a CSF venous fistula, an abnormal connection where a blood vessel and the space around the spine where the cerebrospinal fluid is stored. That type of leak is even trickier to diagnose and cannot be fixed with a blood patch, said Dr. Insun Chon, a neuroradiologist at Houston Methodist.
"No matter how much blood you inject, you're still going to have that abnormal blood vessel there," he said.
In 2021, Roberts opted for a surgery that involved cutting into her back and using surgical clips to seal the leak. At that time, there were no hospitals in Texas that offered the procedure. It took four months to schedule a trip to Cedars-Sinai Medical Center in Los Angeles for treatment.
The surgery kept Roberts hospitalized for a week, but she noticed a "night-and-day" difference afterward.
"I could recall things. I could function," she said. "Everything was just like it was before."
A simpler solution
The fix turned out to be temporary, though. Roberts' headaches and memory loss returned by 2023.
A Houston Methodist neurosurgeon confirmed another leak, but offered Roberts an alternative to another trip to California. He suggested a novel, minimally-invasive procedure that involved inserting a catheter into Roberts' groin to seal the leak.
The surgeon, Dr. Kurt Yaeger, had never attempted the procedure, known as endoscopic embolization. But Roberts trusted him to give it a try.
Yaeger had used the technique to treat other problems, such as brain aneurysms and vascular malformations. But Roberts was his first patient with a CSF leak.
"She was game to try it, and I very much appreciate her for that," Yaeger said.
Yaeger began by inserting a catheter in a large blood vessel in her leg. He then moved the catheter to smaller blood vessels until he reached the leak in her spine. He then patched it with a substance that functions like super glue.
Roberts went home the day of the surgery, which has benefited her just as much as the more intensive procedure, her husband said.
"It was pretty much like plugging a flat tire," Rick Roberts said. "She's back to normal."
Pioneering a treatment
Treating Roberts helped the Houston Methodist team recognize they could fill a void by using the minimally invasive procedure to treat more CSF leak patients. Yaeger, Chong and neurosurgeons Dr. Alex Hoang and Dr. Meng Huang have spearheaded the effort and are now treating multiple patients each week, mostly from Texas, Louisiana and Oklahoma.
Houston Methodist is the only hospital in Texas that offers treatment for the condition, according to the Spinal CSF Leak Foundation. The nonprofit also lists just one CSF leak practice apiece in Alabama, Arizona and Oklahoma, and none in 29 states, including Arkansas, Louisiana, Mississippi and New Mexico.
The scarcity is partly because the condition has long been underdiagnosed, Chong said. He believes that may be due in part to the fact that about two-thirds of leaks are diagnosed in women; studies have found that doctors are more likely to dismiss women who complain of chronic pain.
"Not even a lot of people in the medical community know that this disease exists," he said. "But it can be incredibly, incredibly debilitating."
Yaeger is hopeful the condition will become more recognized over time, and that more hospitals will offer treatment for the condition. He also believes the minimally invasive approach should become the standard of practice because of its benefit to patients.
"It's very straightforward," he said. "And once you do a couple procedures, it becomes more intuitive."
Roberts also hopes stories like hers will bring more attention to CSF leaks. She believes there are others with undiagnosed leaks who are suffering like she was, and who could be cured by a diagnosis and treatment.
"It makes me very emotional, because I know how sick I was and how bad things were," she said. "Now I can enjoy my life."
