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Open Access Highly Accessed Research article

Lumbar puncture-related cerebrospinal fluid leakage on magnetic resonance myelography: is it a clinically significant finding?

Keita Sakurai1*, Noriyuki Matsukawa2, Kenji Okita2, Minoru Nishio3, Masashi Shimohira4, Yoshiyuki Ozawa4, Susumu Kobayashi4, Takemori Yamawaki5 and Yuta Shibamoto4

Author Affiliations

1 Department of Diagnostic Radiology, Tokyo Metropolitan Medical Center of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo 173-0015, Japan

2 Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

3 Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

4 Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

5 Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, Japan

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BMC Anesthesiology 2013, 13:35  doi:10.1186/1471-2253-13-35

Published: 27 October 2013

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.

Conclusion

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.

Keywords:
Lumbar puncture; Cerebrospinal fluid leakage; Post-dural puncture headache; Magnetic resonance myelography; Magnetic resonance imaging