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What Causes Headache And Vomiting Post Lumbar Puncture?
Question: Diagnosis two weeks ago with viral meningitis. Three days in Acute care. Home for three days then back for epidural blood patch. When prone I'm weak and mild headache. Upright more then an hour I have vomiting and fever of 103
Brief Answer:
Intracranial hypotension
Detailed Answer:
I read your question carefully and I understand your concern, those symptoms are worrying.
Headache and vomiting when standing are typical for intracranial hypotension. That is usually a complication due to the lumbar puncture you've had which cause a leak of cerebrospinal fluid (CSF) due to the puncture and as a result low pressure, exacerbated when in a vertical position as there is even less CSF above due to the gravity. I am a little perplexed from the fever though, it doesn't usually accompany intracranial hypotension and a blood test is needed to check for an infectious complication as well as an MRI to look for meningeal changes. Spinal MRI can evidence at times the site of the leak.
Now the blood patch is the correct first step in the management. Caffeine is also often effective. If the first blood patch is not effective enough in sealing the leak a second one may be tried with success. Corticosteroids, good hydration, salt diet are other usual measures although not of proven efficacy.
If blood patches and steroids are not effective enough then a surgical procedure might be necessary to seal the leak.
I remain at your disposal for further questions.
Intracranial hypotension
Detailed Answer:
I read your question carefully and I understand your concern, those symptoms are worrying.
Headache and vomiting when standing are typical for intracranial hypotension. That is usually a complication due to the lumbar puncture you've had which cause a leak of cerebrospinal fluid (CSF) due to the puncture and as a result low pressure, exacerbated when in a vertical position as there is even less CSF above due to the gravity. I am a little perplexed from the fever though, it doesn't usually accompany intracranial hypotension and a blood test is needed to check for an infectious complication as well as an MRI to look for meningeal changes. Spinal MRI can evidence at times the site of the leak.
Now the blood patch is the correct first step in the management. Caffeine is also often effective. If the first blood patch is not effective enough in sealing the leak a second one may be tried with success. Corticosteroids, good hydration, salt diet are other usual measures although not of proven efficacy.
If blood patches and steroids are not effective enough then a surgical procedure might be necessary to seal the leak.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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