A Case of Post-dural Puncture Headache with a Large Amount of Cerebrospinal Fluid in the Thoracic Spine away from the Puncture Site

Abstract

Headaches often occur after a lumbar puncture, and it is considered to be caused by cerebrospinal fluid leakage from the puncture site. A 24-year-old woman presented to our hospital with a headache and fever and underwent a lumbar puncture to investigate meningitis. She complained of severe headache and back pain after the procedure. Here, we report a case of extensive cerebrospinal fluid retention in the thoracic epidural space confirmed through magnetic resonance imaging (MRI) . A 24-year-old woman with fever(body temperature, approximately 39℃)and headache presented to our hospital and was admitted to the neurosurgery outpatient clinic for the diagnosis of meningitis. Lumbar puncture was performed using a 22-G spinal needle. The cerebrospinal fluid was drained in one puncture, and approximately 5 ml of cerebrospinal fluid was collected. The procedure ended without complications. However, she had severe orthostatic headache and back pain the next day；therefore head MRI and spinal MRI were performed. Head MRI showed mild-enhancement of the dura mater, whereas spinal cord MRI showed a large amount of cerebrospinal fluid retention at the dorsal epidural area of the spinal cord in the thoracic spine but not in the lumbar spine. Her symptoms improved with infusion and rest alone, and a blood patch was not necessary. Two weeks later, MRI was performed, and it was confirmed that cerebrospinal fluid retention had resolved. After the lumbar puncture, MRI of the area surrounding the puncture site, as well as the cervical and thoracic vertebrae, is useful for diagnosing cases of cerebrospinal leakage.