title: Lumbar puncture-related cerebrospinal fluid leakage on magnetic resonance myelography: is it a clinically significant finding?
abstract: BACKGROUND
  Post-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.
  
  
  METHODS
  Clinical 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.
  
  
  RESULTS
  Of 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Diagnostic Radiology, Tokyo Metropolitan Medical Center of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo 173-0015, Japan. ksak666@yahoo.co.jp.
authors.forename: Keita
authors.initials: K
authors.lastname: Sakurai
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Matsukawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Okita
authors.forename: Minoru
authors.initials: M
authors.lastname: Nishio
authors.forename: Masashi
authors.initials: M
authors.lastname: Shimohira
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ozawa
authors.forename: Susumu
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Takemori
authors.initials: T
authors.lastname: Yamawaki
authors.forename: Yuta
authors.initials: Y
authors.lastname: Shibamoto