Question of the Week # 208

208)  A 31 Year old woman with suspected diagnosis of Idiopathic intracranial hypertension underwent a lumbar puncture. An MRI of the brain that was obtained prior to lumbar puncture did not reveal any structural abnormalities or mass effect. Laboratory investigations including coagulation parameters were normal. About 12 hours after the procedure, she complains of moderate to severe headache. Headache is mainly in the occipital region which increases while sitting up and improves on lying flat. She has two episodes of vomiting in the last one hour. She also complains of dizziness and ringing sensation in her ears.  Physical examination does not reveal any papilledema or focal neurological deficits. Most appropriate next step in managing this patient?

A)     Blood cultures

B)      MRI of the Lumbar Spine

C)      Non-Contrast CT scan of brain

D)     Observation

E)      Acetazolamide

4 Responses

  1. ans.D observation

  2. C

  3. D….
    post lumbar puncture headache. Diagnosis depends on classic postural changes and tiome of onset of headache after LP. resolves in 24 hours. If persistent needs CT scan to rule out subdural hematoma.

  4. D:) Post lumbar puncture headache.

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