title: Cerebrospinal fluid leakage and headache after lumbar puncture: a prospective non-invasive imaging study.
abstract: The spatial distribution and clinical correlation of cerebrospinal fluid leakage after lumbar puncture have not been determined. Adult in-patients receiving diagnostic lumbar punctures were recruited prospectively. Whole-spine heavily T2-weighted magnetic resonance myelography was carried out to characterize post-lumbar puncture spinal cerebrospinal fluid leakages. Maximum rostral migration was defined as the distance between the most rostral spinal segment with cerebrospinal fluid leakage and the level of lumbar puncture. Eighty patients (51 female/29 male, mean age 49.4 ± 13.3 years) completed the study, including 23 (28.8%) with post-dural puncture headache. Overall, 63.6% of periradicular leaks and 46.9% of epidural collections were within three vertebral segments of the level of lumbar puncture (T12-S1). Post-dural puncture headache was associated with more extensive and more rostral distributions of periradicular leaks (length 3.0 ± 2.5 versus 0.9 ± 1.9 segments, P = 0.001; maximum rostral migration 4.3 ± 4.7 versus 0.8 ± 1.7 segments, P = 0.002) and epidural collections (length 5.3 ± 6.1 versus 1.0 ± 2.1 segments, P = 0.003; maximum rostral migration 4.7 ± 6.7 versus 0.9 ± 2.4 segments, P = 0.015). In conclusion, post-dural puncture headache was associated with more extensive and more rostral distributions of periradicular leaks and epidural collections. Further, visualization of periradicular leaks was not restricted to the level of dural defect, although two-thirds remained within the neighbouring segments.
authors: 1 Institute of Clinical Medicine, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Taipei, 11217, Taiwan 2 Faculty of Medicine, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Taipei, 11217, Taiwan 3 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei, 11217, Taiwan.
authors: Yen-Feng
authors: YF
authors: Wang
authors: 2 Faculty of Medicine, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Taipei, 11217, Taiwan 3 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei, 11217, Taiwan.
authors: Jong-Ling
authors: JL
authors: Fuh
authors: 2 Faculty of Medicine, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Taipei, 11217, Taiwan 4 Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei, 11217, Taiwan.
authors: Jiing-Feng
authors: JF
authors: Lirng
authors: 2 Faculty of Medicine, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Taipei, 11217, Taiwan 3 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei, 11217, Taiwan.
authors: Shih-Pin
authors: SP
authors: Chen
authors: 2 Faculty of Medicine, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Taipei, 11217, Taiwan 5 Department of Anaesthesiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei, 11217, Taiwan.
authors: Shu-Shya
authors: SS
authors: Hseu
authors: 1 Institute of Clinical Medicine, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Taipei, 11217, Taiwan.
authors: Jaw-Ching
authors: JC
authors: Wu
authors: 2 Faculty of Medicine, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Taipei, 11217, Taiwan 3 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei, 11217, Taiwan 6 Institute of Brain Science, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Taipei, 11217, Taiwan sjwang@vghtpe.gov.tw.
authors: Shuu-Jiun
authors: SJ
authors: Wang
mesh_terms: D017217:Blood Patch, Epidural; D065634:Cerebrospinal Fluid Leak / Q000150:complications / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D051299:Post-Dural Puncture Headache / Q000150:complications / Q000209:etiology* / Q000473:pathology*; D011446:Prospective Studies; D013129:Spinal Puncture / Q000009:adverse effects*
keywords: cerebrospinal fluid leakage; magnetic resonance myelography; post-dural puncture headache; spontaneous intracranial hypotension