Abstract
Headache is a common complication after diagnostic lumbar puncture (DLP). We aimed to check whether hydration before puncture influences the incidence of post-lumbar puncture headache (PLPH) and affects cerebral blood flow. Ninety-nine patients enrolled for puncture were assigned to a group with (n = 40) or without hydration (n = 59). In the hydration group, 1000 mL 0.9% NaCl was infused and a minimum of 1500 mL oral fluids was recommended within the 24 h before puncture. A Transcranial Doppler (TCD) was performed before and after DLP. Mean velocity (Vm) and pulsatility index (PI) were measured in the middle cerebral arteries (MCAs). PLPH occurred in 28 patients (28.2%): six (15.4%) from the hydrated and 22 (37.3%) from the non-hydrated group (p < 0.023). Patients with PLPH were younger (p < 0.014) and with headaches in their histories (p < 0.036) compared with the non-headache group. Vm values in both MCAs after puncture were significantly lower than before puncture in all patients. In the PLPH group, Vm in MCAs before puncture were significantly higher and the PI was lower than in the non-headache group. Our findings suggest that hydration of patients within 24 h before puncture prevented PLPH. Twenty-four hours after puncture, significant decreases in Vm were observed in the MCAs of all patients. Low baseline values of PI and high Vm predisposed patients to PLPH.
Highlights
Diagnostic lumbar puncture (DLP) is a frequently performed medical procedure, which is important in the diagnosis of nervous system diseases
This is why we decided to check whether hydration before puncture influences the incidence of Post-lumbar puncture headache (PLPH) and causes changes in cerebral blood flow (CBF) which are reflected in Transcranial Doppler ultrasonography (TCD)
Post-lumbar puncture headache is probably caused by leakage of the cerebrospinal fluid through the post-puncture opening, which leads to a decrease in intracranial pressure and dilation of the cerebral vessels [1,2,3,5]
Summary
Diagnostic lumbar puncture (DLP) is a frequently performed medical procedure, which is important in the diagnosis of nervous system diseases. The loss of cerebrospinal fluid causes a drop in intracranial pressure (ICP), leading to the compensative dilatation of cerebral vessels and the headache [1,2,3,5]. DLP results in significant changes in cerebral blood flow (CBF) that can be visualized by TCD [9,10,11]. The results of a few current studies have unambiguously confirmed that hydration of patients after puncture prevents PLPH [13,14,15].
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