Hypotension and transient renal impairment induced by lumbar puncture

Introduction  Raised intracranial pressure (ICP) may induce hypertension through sympathetic mechanisms. Methods  Case report. Results  A 55-year-old man was admitted with a symptomatic intracerebral mass and new refractory arterial hypertension. Several antihypertensive medications were necessary to control his blood pressure. A lumbar puncture was performed for diagnostic purposes and raised opening pressure (42 cm H₂O) denoted raised ICP. After cerebrospinal fluid extraction, the closing pressure dropped to normal level. Shortly after the lumbar puncture, a sudden and pronounced drop in blood pressure was noted. Over the next day, the patient's serum creatinine rose from 0.9 to 1.9 mg/dL. Blood pressure normalized after discontinuation of all antihypertensive drugs and administration of intravenous fluids. Renal function also completely recovered within 2 days. The patient remained spontaneously normotensive thereafter. Conclusion  Sudden hypotension may occur after lumbar puncture in patients with raised ICP receiving treatment for arterial hypertension.