The condition may be frustrating to diagnose even when the cause is strongly suspected, particularly in the less dramatic cases. MRI of the neck and back occasionally reveals spinal fluid leaking out of its normal location. Computed tomography CT myelogram a CT scan of the back after dye is injected into the spinal fluid may reveal the site of the leak directly.
CSF cisternogram — a procedure in which a radioactive dye is injected in the spinal fluid and detected by a special radiation-detecting camera — may reveal the leak directly, or may only show indirect evidence of the leak's presence but not its exact location.
Lumbar puncture spinal tap may reveal lower than normal spinal fluid pressure, but might increase the severity of the symptoms temporarily.
Sometimes we are percent sure a leak is lurking somewhere but may be unable to find it with any test. Treatment usually begins conservatively with strict bed rest, increased fluid intake, and caffeine either in drink form or by pill.
If this cautious approach fails to result in closure of the hole, an epidural blood patch may be performed. In this procedure, the patient's own blood is removed from a vein with a syringe and injected into the spine, either at the exact site of the leak or at a safe location in the low back.
Often a blood patch results in rapid plugging of the hole and nearly immediate relief of symptoms. This procedure may need to be repeated a few times to be successful. If they have signs of midline shift, obstructive hydrocephalus, or cerebral edema, then an LP should be avoided.
Top image 5. Previous Next. Neurological and Neurosurgical Procedures: Lumbar Puncture. In: Emergency Medicine Procedures. McGraw Hill; Lee S, Lueck C. Cerebrospinal fluid pressure in adults. J Neuroophthalmol. CSF opening pressure: reference interval and the effect of body mass index. Cerebrospinal fluid analysis. Am Fam Physician. Medical gallery of Blausen Medical WikiJournal of Medicine. Published Accessed February 11, You may also experience nausea, dizziness or lightheadedness. Stopping the fluid drain for a few minutes will usually relieve these symptoms.
A similar headache can occur after the tube is removed. You should drink plenty of caffeine containing fluids and take ibuprofen or acetaminophen as needed. If this kind of headache persists, a blood patch may be applied to the area to seal the fluid leak. Bleeding : Bleeding is minimal during the procedure.
There is a potential for bleeding around the brain if excess fluid is drained. To decrease the chance of this complication, please notify the nurse when you change positions or have to use the bathroom.
Spinal fluid leak : Rarely, spinal fluid may leak around the catheter and its dressing. If it leaks onto a non-sterile area, the physician may decide to remove the catheter. Depending on how much you have drained, a new one may be put in, or multiple spinal taps may be done to drain more spinal fluid.
Your doctor will carefully analyze the information obtained from your intracranial pressure monitoring procedure and consider it along with data from other tests, such as eye examination, shunt studies, MRI or CT scans. This process can take up to a week. Experts at the Cerebral Fluid Center discuss complex cases at their weekly case conference to confer on the best course of treatment.
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