Headache after lumbar puncture
Last reviewed: 23.04.2024
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Headache can be the result of a decrease in the volume and pressure of cerebrospinal fluid (CSF) due to lumbar puncture or as a result of cerebrospinal fluid.
Withdrawal of the CSF by lumbar puncture (LP) reduces the volume and pressure of the CSF, as in the case of spontaneous cerebrospinal fluid (for example, from the arachnoid cysts of the spinal canal, which can be ruptured by coughing or sneezing). Raising the head in a sitting or standing position leads to stretching of the sensitive cerebral membranes of the base of the skull, causing a headache. A severe headache depends on the position of the body and is accompanied by pain in the neck, meningism and vomiting. Headache calms down only when lying down.
Headache after lumbar puncture is quite common, usually developing in the interval from a few hours to one or two days after the procedure and can be debilitating. The risk of developing headache after lumbar puncture is increased in young people with a small body weight. The risk can be reduced by using needles of small size. The amount of withdrawn cerebrospinal fluid and the length of stay in the supine position after lumbar puncture does not affect the frequency of episodes of headache.
Headache after lumbar puncture is clinically obvious, and diagnostic measures are rarely performed; other variants of hypotensive headache require additional research using CT or MPT. MPT with gadolinium shows a diffuse accumulation of contrast in a hard shell and, in severe cases, a downward displacement of the brain. CSF pressure is usually reduced or not determined if the patient has been in an upright position for some time (gravity increases the loss of CSF).
Priority measures are the adoption of a horizontal position, the introduction of infusion therapy, wearing an elastic abdominal bandage, taking light analgesics and caffeine. If these measures do not eliminate the headache after lumbar puncture within 24 hours, you can try the "epidural blood seal" (injection of several milliliters of the vein's vein in the epidural space). Surgical interventions for spontaneous liquorrhea are rarely required.
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