In addition to the postural component, which sign is NOT typically associated with postdural puncture headache?

In addition to the postural component, which sign is NOT typically associated with postdural puncture headache?

• A. Double vision
• B. Nausea and vomiting
• C. Hearing changes
• D. Fever

Answer: (D)

When dural puncture occurs, CSF leaks reduce intracranial pressure, causing the classic headache that worsens when upright. This low-pressure state can create traction on cranial nerves and alter inner ear fluid dynamics, so signs like double vision from cranial nerve VI palsy, and nausea or vomiting, as well as hearing changes or tinnitus, are commonly seen. Fever, by contrast, isn’t a feature of the CSF-pressure–driven process itself; it points more toward an infection or meningitis and would prompt evaluation for an infectious complication rather than being part of postdural puncture headache.

When dural puncture occurs, CSF leaks reduce intracranial pressure, causing the classic headache that worsens when upright. This low-pressure state can create traction on cranial nerves and alter inner ear fluid dynamics, so signs like double vision from cranial nerve VI palsy, and nausea or vomiting, as well as hearing changes or tinnitus, are commonly seen. Fever, by contrast, isn’t a feature of the CSF-pressure–driven process itself; it points more toward an infection or meningitis and would prompt evaluation for an infectious complication rather than being part of postdural puncture headache.