Headaches due to arachnoid leak

Ifound the report by Jana Thoennissen and colleagues on bed rest after cervical or lumbar puncture to be a very searching study.¹ If a patient experiences headaches post-puncture while in an upright position and the headaches are relieved by recumbency, it means there is an arachnoid leak. Every neurosurgeon who has done a laminectomy over the puncture site has occasionally seen pulsating extrusion of fluid at the dural opening. This often occurs because a “wick” of arachnoid has been dragged back through the dura as the needle is removed. This wick keeps the arachnoid open through the dura. It occurs because the needle struck bone on the way in, creating a miniature barb on the needle. If bone is struck on the way in, the needle should be discarded and a new one used.

Dwight Parkinson Department of Human Anatomy and Cell Science Faculty of Medicine University of Manitoba Winnipeg, Man.