Which is a common complication of lumbar puncture and how is it usually managed?

• A. Meningitis; treated with intravenous antibiotics.
• B. Subarachnoid hemorrhage; managed with surgery.
• C. Post-dural puncture headache; bed rest, hydration, caffeine, or epidural blood patch if severe.
• D. Pulmonary embolism; treated with anticoagulation.

Answer: (C)

The main concept here is that the most common complication after a lumbar puncture is a post-dural puncture headache, caused by leakage of CSF from the puncture site. When CSF escapes, the intracranial pressure drops and the brain can sag slightly, triggering a headache that typically worsens when standing or sitting up and improves when lying down.

Management starts with conservative measures: bed rest and increased fluids to support CSF volume, and caffeine can help because it has vasoconstrictive effects and may reduce CSF leakage-related symptoms. If the headache is severe or persistent despite these measures, an epidural blood patch is used. This procedure injects the patient’s own blood into the epidural space near the puncture, forming a clot that seals the dural leak and typically provides rapid relief.