Cerebral blood flow characteristics in patients with post-lumbar puncture headache

Abstract

The aim of this study was to verify if diagnostic lumbar puncture (DLP) in post-lumbar puncture headache (PLPH) patients is related to significant changes in cerebral blood flow which could be visualized by transcranial Doppler (TCD). Sixty-six patients were enrolled in this study. TCD was performed 24 h before DLP and repeated within 24 h after the procedure. The measurements included mean velocity (Vmean), peak systolic velocity (Vmax), and Gosling’s pulsatility index (PI), in the left and right middle cerebral artery (MCA). PLPH was observed in 21 patients (32%). No significant differences were noted in Vmean, Vmax and PI between the right and left MCAs—both before DLP and following this procedure. In patients who developed PLPH, bilateral pre-puncture values of Vmean and Vmax were significantly higher and PI was significantly lower compared to unaffected individuals. No significant differences were observed between these groups in terms of post-puncture Vmean and Vmax, but the post-puncture PI was still significantly lower in PLPH cases. In PLPH cases, the post-puncture values of Vmean and Vmax were significantly lower than the respective baseline parameters. A significant inverse correlation was present between PLPH severity and bilateral pre-puncture PI. In conclusion, this study revealed that higher baseline values of Vmean and Vmax and low PI in bilateral MCAs predispose patients to PLPH.

Cerebral Blood Flow in Low Intracranial Pressure Headaches—What Is Known?

“…In patients who developed PDPHs, the post-puncture values of Vm in both MCAs were significantly lower than the parameters before punctures. The decrease of Vm observed in this group of patients may result from the dilatation of intracranial vessels, a consequence of lowered ICP, so the findings of this study partially confirmed the theory behind the etiology of PDPHs [28]. Another study aimed to check whether hydration before puncture influenced the incidences of post-dural-puncture headaches and affected CBF in 99 patients enrolled for diagnostic lumbar punctures [43].…”

“…In a study of 66 patients who required diagnostic lumbar punctures, CBF was assessed 24 h before and within 24 h after the procedures [28]. In patients who developed PDPHs, the post-puncture values of Vm in both MCAs were significantly lower than the parameters before punctures.…”

The relationship between body mass index and post-dural puncture headache in obstetric patients

“…Although not always associated pathologically, PDPH is usually associated with a reduced intracranial volume, downward brain displacement and compensatory increase in cerebral blood flow. 15,16 PDPH has the potential to cause significant morbidity, may persist for weeks [2][3][4]6 and is associated with chronic headaches. 17 The incidence of ADP from either an epidural or CSE in our teaching institution was 0.7%.…”

Actualización sobre factores de riesgo para cefalea pospunción dural

“…Lybecker H y cols, realizaron 117 punciones lumbares de los cuales cinco desarrollaron CPPD, dos de tres casos tenían antecedentes de CPPD y tres de 114 casos sin este antecedente, demostrando en su estudio que el antecedente de CPPD es un factor predictor significativo para la patología (p=0,0018) 24 . Así mismo, la incidencia de CPPD es mayor en pacientes con antecedentes de cefalea, principalmente cefalea tensional 25 . Kuntz KM y cols, concluyeron que el grupo de pacientes con antecedentes de cefalea una semana previa a la punción dural tenía un incidencia de CPPD del 70% 7 .…”