Factors Associated With the Onset and Persistence of Post–Lumbar Puncture Headache

Abstract

DESIGN, SETTING, AND PARTICIPANTSWe performed univariate and multivariable analyses of 338 lumbar punctures in the Dominantly Inherited Alzheimer Network observational study using linear mixed models, adjusting for participant-level and family-level random effects. MAIN OUTCOMES AND MEASURESWe directly evaluated associations of 3 post-lumbar puncture outcomes (immediate postprocedural headache, PDPH at 24-hour follow-up, and PDPH receiving a therapeutic blood patch) with participant age and sex, positioning, collection method, needle size, needle insertion site, and cerebrospinal fluid (CSF) volume collected. RESULTSThe incidence of adverse events included 73 immediate postprocedural headaches (21.6%), 59 PDPHs at 24-hour follow-up (17.5%), and 15 PDPHs receiving a therapeutic blood patch (4.4%). Greater volume of CSF collected was associated with increased risk of immediate postprocedural headache, largely owing to a nonlinear increase in risk on collection of volumes above 30 mL (odds ratio, 3.73 for >30 mL and 0.98 for <17 mL). In contrast, collection of higher volumes showed a protective effect in decreasing rates of PDPH at 24-hour follow-up and rates of PDPH receiving a therapeutic blood patch (odds ratio, 0.35 per 10 mL). Although differences in needle size did not reach statistical significance, no participant in the 24G needle group received a therapeutic blood patch compared to 8 of 253 for the larger 22G needles. CONCLUSIONS AND RELEVANCEFactors that acutely lower CSF pressure (eg, seated positioning or extracting very high volumes of CSF) may be associated with transient post−lumbar puncture headache, without increasing rates of persistent PDPH or therapeutic blood patch. Collection of up to 30 mL of CSF appears to be well tolerated and safe.

Factors Influencing Successful Lumbar Puncture in Alzheimer Research

“…Lastly, we found an effect of the volume of CSF collected on LP headache; collection of >20 mL CSF was protective (compared to ≤20 mL), consistent with the work of Monserrate and colleagues. 31 Higher volumes of CSF may be protective against LP headache because transiently lower CSF pressure may decrease leakage through the dural puncture, facilitating dural closure. 31 Alternatively, headache incidence may be higher in LP attempts in which complications led to early termination of the procedure, with less CSF collected.…”

Early changes in CSF sTREM2 in dominantly inherited Alzheimer’s disease occur after amyloid deposition and neuronal injury

“…The presence of an ADAD mutation and the APOE genotype was determined using standard methods described elsewhere (66). CSF collection followed standard procedures (59, 67), and the measurements of CSF Aβ 1–42 , T-tau, and P-tau 181P were performed using the Luminex bead–based multiplexed xMAP technology (INNO-BIA AlzBio3, Innogenetics) (59). …”

CSF progranulin increases in the course of Alzheimer's disease and is associated with sTREM 2, neurodegeneration and cognitive decline

“…All DIAN participants underwent a comprehensive clinical and neuropsychological evaluation (Bateman et al , ; Storandt et al , ). CSF collection follows standard procedures (Fagan et al , ; Monserrate et al , ), and the measurements of T‐tau, P‐tau 181P and CSF Aβ 1–42 were performed by the Luminex bead‐based multiplexed xMAP technology (INNO‐BIA AlzBio3, Innogenetics; Fagan et al , ). The estimated years from expected symptom onset (EYO) is calculated as the difference between the participant's age at evaluation and the mean age at onset of all other affected family members (Bateman et al , ; Ryman et al , ).…”