MR imaging with gadolinium in patients with and without post-lumbar puncture headache

Purpose. To study frequency and extent of meningeal enhancement in patients with and without post-lumbar puncture headache (PLPH) with cerebral MR wit h Gd-DTPA. Material and Methods. Ten consecutive patients with PLPH and 9 consecutive patients without PLPH were included in the study. Nine of the PLPH patients were reinvestigated when the PLPH was over and all non-PLPH patients durin g the week after the lumbar puncture. Results. Eight of the 9 patients with PLPH showed more enhancement of menin geal structures during PLPH than when PLPH had disappeared. The differences were slight in 5, more marked in 2, and pronounced in 1 patient. The 9th p atient showed no change at all. In the 9 patients without PLPH. there was m ainly slight enhancement before lumbar puncture and no change in enhancemen t after lumbar puncture as compared with before. Conclusion. PLPH is related to increased Gd-DTPA enhancement of the meninge s, although the increase in enhancement during PLPH is minor in most cases. Pronounced enhancement of the meninges after lumbar puncture may predict l ong duration of the PLPH.