Intracranial Hypotension in Pediatric Oncology Patients Following Lumbar Puncture: A Case Series

A bstract Many pediatric patients with leukemia undergo lumbar punctures (LP) for intrathecal (IT) chemotherapy. Patients who experience post-LP headaches may be suffering from intracranial hypotension due to persistent leakage of cerebrospinal fluid through the meninges. The purpose of this study was to analyze clinical features of intracranial hypotension secondary to LP. This IRB-approved retrospective, single-center study included patients aged of 5–21 with an oncologic condition who experienced a neurologic complication secondary to LP. Five patients were identified with a diagnosis of intracranial hypotension in the setting of a recent LP. Patients reported postural headache on average 3.8 days after receiving IT methotrexate. Brain magnetic resonance imaging confirmed diagnosis. Three of the five patients received an epidural blood patch with resolution. The additional two patients were treated with intravenous caffeine and dihydroergotamine. Many patients showed resolution of symptoms with treatment. Future studies would investigate optimal management strategies for pediatric patients with persistent symptoms.