Lumbar puncture headache

[SAcreed]

background

it is a well known phenomenon attributable to lowering of intcranial pressure by leakage of csf .

pathogenesis

The pain is presumably the result of a reduction of CSF pressure
and tugging on cerebral and dural vessels as the patient assumes
the erect posture.

clinical manifestations

once begun the headache prevails for days and in rare instances for weeks.
Actually the syndrome includes more than headache. there may be pain at the base of skull posteriorly and in the back of the neck and upper thoracic spine,stiffness of the neck, and nausea and vomiting. At times signs of meningeal irritations are so prominent that it resembles the postlumbar puncture meningitis..

occasionally there will be sixth nerve palsy or self audible bruit from turbulence in the intracranial venous system.

there is characteristic relationship between pain in upright posture and its relief after assuming recumbent position.

on mri it is accounted as prominent dural enhancement with gadolinium and in severe cases as subdural effusions and mass effect.
the dural manifestation is assumed to be the outcome of neovascularization and of pachymeninges(dura) and perhaps venous dilation in response to the lowered subarachnoid pressure.

prevention and management

the use of 22 to 24 gauge needle and the performance of single clean atraumatic tap seemingly halves the risk of post lumbar puncture headache..

commonly implied method is forced recumbency or oral fluid administration after the lp.

i) blood patch ;spinal epidural injection of few milliliters of patients own blood

ii) 1000 to 2000 ml of 5% of glucose

iii) caffeine-ergotamine preparations or iv caffeine

iv) large volumes of fluid

Despite their profound use benefits are still not satisfactory. The most dependable of them is blood patch in which cases of immediate relief had been reported.

references

articles from cabat and van crevel
principles of neurology by maurice and allian 8th edition