CENTRAL NERVOUS SIDE-EFFECTS AFTER LUMBAR PUNCTURE - A REVIEW OF THE POSSIBLE PATHOGENESIS OF THE SYNDROME OF POSTDURAL PUNCTURE HEADACHE AND ASSOCIATED SYMPTOMS

The mechanism of central nervous side effects of lumbar puncture is re viewed on the basis of the literature. The most frequent adverse effec t of lumbar puncture remains the postdural puncture headache; dysfunct ion of certain cranial nerves occurs less frequently. Laboratory studi es have shown that the cerebrospinal fluid (CSF) leak through a dural puncture site by far exceeds the production rate of CSF. Several repor ts suggest that lumbar CSF leakage may affect the intracranial CSF vol ume. There are no reports of measurement of the intracranial pressure in patients with postdural puncture headache, but there are several in dications of a reduced CSF pressure that may explain postdural punctur e headache and vestibulocochlear dysfunction following lumbar puncture . Recent audiometric studies suggest that hearing loss may be a sensit ive indicator of CSF leakage, and larger series indicate that the need le size and the shape of the needle tip are important determinants of the incidence of central nervous side effects. Epidural blood patch ma y give immediate relief of postdural puncture headache and cranial ner ve dysfunction after lumbar puncture, but the reason for the rapid and impressive effect of epidural blood patch has not been fully elucidat ed.