Leakage of CSF following a dural puncture may be of sufficient volume to elicit symptoms of intracranial hypotension. Postdural puncture headaches occur with an estimated frequency of 2% to 8% [13-15]. Risk factors for postdural puncture headaches include the use of a larger gauge needle, multiple attempts at dural puncture, the use of a cutting needle versus pencil point tip needle, needle orientation perpendicular rather than parallel to spine longitudinal axis (when using a cutting needle), and dural puncture in the sitting position as opposed to lateral decubitus positioning [55-58]. Imaging is not typically indicated in this clinical setting because postdural puncture headaches are typically self-limited, with most symptoms fully resolving within 1 week without any treatment [13]. The initial management of postdural puncture headaches is conservative medical management, with consideration of epidural blood patch if symptoms are severe or not beginning to resolve by 2 to 3 days postdural puncture [59- 61]. Imaging of Suspected Intracranial Hypotension CT Complete Spine With IV Contrast There is no relevant literature to support the use of CT complete spine with IV contrast in the initial imaging of suspected intracranial hypotension within 72 hours of dural puncture. CT Complete Spine Without and With IV Contrast There is no relevant literature to support the use of CT complete spine without and with IV contrast in the initial imaging of suspected intracranial hypotension within 72 hours of dural puncture. CT Complete Spine Without IV Contrast There is no relevant literature to support the use of CT complete spine without IV contrast in the initial imaging of suspected intracranial hypotension within 72 hours of dural puncture. CT Head Cisternography There is no relevant literature to support the use of CT head cisternography in the initial imaging of suspected intracranial hypotension within 72 hours of dural puncture.
Imaging of Suspected Intracranial Hypotension PCAs. Leakage of CSF following a dural puncture may be of sufficient volume to elicit symptoms of intracranial hypotension. Postdural puncture headaches occur with an estimated frequency of 2% to 8% [13-15]. Risk factors for postdural puncture headaches include the use of a larger gauge needle, multiple attempts at dural puncture, the use of a cutting needle versus pencil point tip needle, needle orientation perpendicular rather than parallel to spine longitudinal axis (when using a cutting needle), and dural puncture in the sitting position as opposed to lateral decubitus positioning [55-58]. Imaging is not typically indicated in this clinical setting because postdural puncture headaches are typically self-limited, with most symptoms fully resolving within 1 week without any treatment [13]. The initial management of postdural puncture headaches is conservative medical management, with consideration of epidural blood patch if symptoms are severe or not beginning to resolve by 2 to 3 days postdural puncture [59- 61]. Imaging of Suspected Intracranial Hypotension CT Complete Spine With IV Contrast There is no relevant literature to support the use of CT complete spine with IV contrast in the initial imaging of suspected intracranial hypotension within 72 hours of dural puncture. CT Complete Spine Without and With IV Contrast There is no relevant literature to support the use of CT complete spine without and with IV contrast in the initial imaging of suspected intracranial hypotension within 72 hours of dural puncture. CT Complete Spine Without IV Contrast There is no relevant literature to support the use of CT complete spine without IV contrast in the initial imaging of suspected intracranial hypotension within 72 hours of dural puncture. CT Head Cisternography There is no relevant literature to support the use of CT head cisternography in the initial imaging of suspected intracranial hypotension within 72 hours of dural puncture.