Cerebral blood flow characteristics in patients with post-lumbar puncture headache

The aim of this study was to verify if diagnostic lumbar puncture (DLP) in post-lumbar puncture headache (PLPH) patients is related to significant changes in cerebral blood flow which could be visualized by transcranial Doppler (TCD). Sixty-six patients were enrolled in this study. TCD was performed 24 h before DLP and repeated within 24 h after the procedure. The measurements included mean velocity (V _mean), peak systolic velocity (V _max), and Gosling’s pulsatility index (PI), in the left and right middle cerebral artery (MCA). PLPH was observed in 21 patients (32%). No significant differences were noted in V _mean, V _max and PI between the right and left MCAs—both before DLP and following this procedure. In patients who developed PLPH, bilateral pre-puncture values of V _mean and V _max were significantly higher and PI was significantly lower compared to unaffected individuals. No significant differences were observed between these groups in terms of post-puncture V _mean and V _max, but the post-puncture PI was still significantly lower in PLPH cases. In PLPH cases, the post-puncture values of V _mean and V _max were significantly lower than the respective baseline parameters. A significant inverse correlation was present between PLPH severity and bilateral pre-puncture PI. In conclusion, this study revealed that higher baseline values of V _mean and V _max and low PI in bilateral MCAs predispose patients to PLPH.