Abstract
BackgroundPost-dural puncture headache (PDPH) due to excessive cerebrospinal fluid (CSF) leakage is a well-known complication of lumbar puncture. Although various factors, especially the type of spinal needle, have been demonstrated to be associated with PDPH, the clinical implications of CSF leakage detected on magnetic resonance myelography (MRM) images remain unclear. The objective of this case–control study was to evaluate the association between radiologically visualized CSF leakage and PDPH.MethodsClinical data including patients’ age and gender, types of spinal needle, duration of bed rest, interval between lumbar puncture procedures and MRM studies, and incidence of PDPH were compared between patients who were radiologically-positive and -negative for CSF leakage.ResultsOf the 22 patients with definite CSF leakage on MRM images, most were asymptomatic (86%, 19/22). The remaining three patients, who were suffering from PDPH, only complained of headaches and were treated conservatively. In a review of patients’ clinical data, there were no significant differences in any parameter including the incidence of PDPH between the 22 patients who were radiologically-positive for CSF leakage and the 31 radiologically-negative patients.ConclusionThe significance of radiologically visualized CSF leakage should not be overestimated, as most such incidents are not associated with PDPH and do not require any treatment.
Highlights
Post-dural puncture headache (PDPH) due to excessive cerebrospinal fluid (CSF) leakage is a well-known complication of lumbar puncture
Puncturing the dura has the potential to lead to excessive CSF leakage, and CSF hypovolemia subsequent to excessive CSF leakage can lead to post-dural puncture headache (PDPH), which has been regarded as a complication of lumbar puncture for over a century [1]
These studies evaluated only a small number of selected subjects, so a larger number of unselected subjects in daily medical practice appear necessary for the evaluation of the clinical implication of radiologically visualized postpuncture CSF leakages. Such iatrogenic CSF leakage can make it difficult to differentiate between PDPH and spontaneous intracranial hypotension (SIH) [4,5]. Taking these problems into consideration, we aimed to investigate the clinical implication of radiologically visualized postpuncture CSF leakage in daily medical practice
Summary
Post-dural puncture headache (PDPH) due to excessive cerebrospinal fluid (CSF) leakage is a well-known complication of lumbar puncture. Especially the type of spinal needle, have been demonstrated to be associated with PDPH, the clinical implications of CSF leakage detected on magnetic resonance myelography (MRM) images remain unclear. The objective of this case–control study was to evaluate the association between radiologically visualized CSF leakage and PDPH. The incidence and clinical implications of radiologically visualized postpuncture CSF leakage have rarely been evaluated [6,7]. These studies evaluated only a small number of selected subjects, so a larger number of unselected subjects in daily medical practice appear necessary for the evaluation of the clinical implication of radiologically visualized postpuncture CSF leakages
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