Amgad Droby1, Nurit Omer2, Tanya Gurevich3, Meir Kestenbaum4, Yair Mina5, Jesse M Cedarbaum6, Orna Aizenstein7, Nir Giladi3, Anat Mirelman1, Avner Thaler8. 1. Movement Disorders Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Laboratory of Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel. 2. Movement Disorders Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Laboratory of Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel. 3. Movement Disorders Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel. 4. Sackler School of Medicine, Tel Aviv University, Israel; Neurology Department, Meir Medical Center, Kfar Saba, Israel. 5. Movement Disorders Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel. 6. Biogen Inc, Cambridge, MA, USA; Coeruleus Clinical Sciences LLC, Woodbridge, CT, USA. 7. Sackler School of Medicine, Tel Aviv University, Israel; Radiology Department, Tel Aviv Medical Sourasky Center, Tel Aviv, Israel. 8. Movement Disorders Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Laboratory of Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel. Electronic address: avnert@tlvmc.gov.il.
Abstract
BACKGROUND: Cerebrospinal fluid (CSF) is essential for the medical workup of patients with neurological conditions and for disease-modifying clinical trials. Post- lumbar puncture (LP) headache is influenced by both operator and patient-related factors, including needle type and gauge, age, and gender. OBJECTIVES: We aimed to assess whether CSF volume measured based on pre-procedural brain MRI is associated with the risk of developing a post-LP headache. METHODS: In total, n = 117 participants (n = 58 Parkinson's disease patients, and n = 59 healthy controls) underwent an LP and CSF collection. Of those, n = 89 underwent MRI scans prior to the LP procedure acquiring high-resolution 3D magnetization-prepared rapid gradient echo (MP-RAGE) T1-weighted images using a 3 T MR scanner. Clinical and behavioral assessments were performed for all participants, and CSF was assessed for content. The T1-weighted images were segmented producing gray matter, white matter, and CSF probability maps. RESULTS: Thirteen participants (11.1%) experienced post-LP headache. They were younger (p = .033) and had lower CSF volumes (p = .040) compared to participants that did not develop a post LP headache. CONCLUSIONS: The results of this pilot study suggest that low CSF volumes might increase the risk for the occurrence of post-LP adverse events and should be taken into consideration when planning LP's.
BACKGROUND: Cerebrospinal fluid (CSF) is essential for the medical workup of patients with neurological conditions and for disease-modifying clinical trials. Post- lumbar puncture (LP) headache is influenced by both operator and patient-related factors, including needle type and gauge, age, and gender. OBJECTIVES: We aimed to assess whether CSF volume measured based on pre-procedural brain MRI is associated with the risk of developing a post-LP headache. METHODS: In total, n = 117 participants (n = 58 Parkinson's diseasepatients, and n = 59 healthy controls) underwent an LP and CSF collection. Of those, n = 89 underwent MRI scans prior to the LP procedure acquiring high-resolution 3D magnetization-prepared rapid gradient echo (MP-RAGE) T1-weighted images using a 3 T MR scanner. Clinical and behavioral assessments were performed for all participants, and CSF was assessed for content. The T1-weighted images were segmented producing gray matter, white matter, and CSF probability maps. RESULTS: Thirteen participants (11.1%) experienced post-LP headache. They were younger (p = .033) and had lower CSF volumes (p = .040) compared to participants that did not develop a post LP headache. CONCLUSIONS: The results of this pilot study suggest that low CSF volumes might increase the risk for the occurrence of post-LP adverse events and should be taken into consideration when planning LP's.