Brief Answer:

Blood patch utility

Detailed Answer:

Hello,

If your headache has definitely been diagnosed as being caused due to a lumbar puncture complication.

In other words, you have terrible headaches when standing or walking which are relieved almost immediately by lying down in repose. and you fail to get a blood patch then, your condition may become chronic.

In a small percentage of cases, the leak will consolidate itself. But it is more common for the leak to be persistent and continue to cause problems of headaches.

I've had several patients sent to me for LP headaches who have chosen not to get blood patched and they've continued for months and in 1 instance 3 years until the symptoms and pain were so unbearable she just had to get resolution.

Also, there is a risk that the puncture hole through which the fluid is leaking can get bigger over time and this can result in worsening headaches and other symptoms due to heavier CSF losses into the epidural space.

My recommendation to whoever is considering NOT getting a blood patch done is to get it done. A competent and experienced neurologist could perform the procedure as well as an anesthesiologist and it takes just a few minutes. The results are almost instantaneous.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Dariush Saghafi, Neurologist

---

Brief Answer:

CLINICAL ACUMEN and MRI

Detailed Answer:

Hello,

1. Clinical acumen of the clinician who did the LP or the consulting neurologist if they can't figure it out. It's a pretty clear cut diagnosis but then again, nothing in medicine should ever be considered "clear cut".

Until AFTER the diagnosis has been made, confirmed, and the patient cured of their problems! Don't you think that's good to proceed?

Always think of alternatives. No matter how obvious. That's how a good doctor proceeds.

Essentially in a person who just underwent an LP and who develops terrible or new onset headaches (even if not necessarily severe), the major question to ask (especially if they are not prone to headaches) is how does your headache feel when you STAND UP? If the answer is.

"I really don't like standing because that's when my headache seems to come on...." and they also tell you that, "Lying down really makes my headache feel a lot better....even go away quickly.....", well then, a diagnosis of CSF leak is on the horizon.

If one had any doubts as to the diagnosis from a clinical perspective then, an MRI of the brain would likely show the presence of CSF fluid in the EXTRADURAL SPACE where it shouldn't be.

The radiologist and neurologist should be able to identify that type of pathology.

So, those are the 2 major ways of coming to the diagnosis.

There is a 3rd way but this is not necessarily going to be seen all the time.

If you sit up for some time and are able to stand the headache without lying down.

There could be a "bulging of sorts or hardening of the area where the LP was done or this area could be fluctuant.

Meaning soft and mushy to the touch and if that area were to be present and persist for at least several days or a week in the face of headaches that come and go depending if you're standing or lying (referred to as: POSTURALLY DEPENDENCY of HEADACHE phenomenon) then, that could be another clue.

Get diagnosed and get the patch if necessary.

Hope I have answered your query.

Take care

Regards,
Dr Dariush Saghafi, Neurologist

---