Cerebrospinal fluid leakage and headache after lumbar puncture: a prospective non-invasive imaging study

The spatial distribution and clinical correlation of cerebrospinal fluid leakage after lumbar puncture have not been determined. Adult in-patients receiving diagnostic lumbar punctures were recruited prospectively. Whole-spine heavily T-2-weighted magnetic resonance myelography was carried out to characterize post-lumbar puncture spinal cerebrospinal fluid leakages. Maximum rostral migration was defined as the distance between the most rostral spinal segment with cerebrospinal fluid leakage and the level of lumbar puncture. Eighty patients (51 female/29 male, mean age 49.4 +/- 13.3 years) completed the study, including 23 (28.8%) with post-dural puncture headache. Overall, 63.6% of periradicular leaks and 46.9% of epidural collections were within three vertebral segments of the level of lumbar puncture (T12-S1). Post-dural puncture headache was associated with more extensive and more rostral distributions of periradicular leaks (length 3.0 +/- 2.5 versus 0.9 +/- 1.9 segments, P = 0.001; maximum rostral migration 4.3 +/- 4.7 versus 0.8 +/- 1.7 segments, P = 0.002) and epidural collections (length 5.3 +/- 6.1 versus 1.0 +/- 2.1 segments, P = 0.003; maximum rostral migration 4.7 +/- 6.7 versus 0.9 +/- 2.4 segments, P = 0.015). In conclusion, post-dural puncture headache was associated with more extensive and more rostral distributions of periradicular leaks and epidural collections. Further, visualization of periradicular leaks was not restricted to the level of dural defect, although two-thirds remained within the neighbouring segments.