Which statement about postdural puncture headaches is true?

Which statement about postdural puncture headaches is true?

• A. Usually occur immediately following dural puncture
• B. Are relieved 8 to 12 hours after an epidural blood patch is performed
• C. Occur more frequently in nonpregnant patients compared with pregnant patients
• D. Can be associated with neurologic deficits

Answer: (D)

Postdural puncture headaches come from CSF leakage after a dural puncture, which lowers intracranial pressure and causes the brain to sag slightly. That sag can traction on the meninges and cranial nerves, so the headache is often orthostatic and may be accompanied by other neurologic signs. Because the downward pull on neural structures can involve cranial nerves, these headaches can be associated with neurologic deficits such as diplopia from a CN VI palsy or other subtle neurologic signs. This makes the statement about possible neurologic deficits true. The other points aren’t as consistent: onset is not usually immediate and often occurs within hours to a couple of days; relief after an epidural blood patch is typically rapid, not reliably delayed to 8–12 hours; and the claim about frequency in pregnant versus nonpregnant patients isn’t a defining, universally true rule for PDPH.

Postdural puncture headaches come from CSF leakage after a dural puncture, which lowers intracranial pressure and causes the brain to sag slightly. That sag can traction on the meninges and cranial nerves, so the headache is often orthostatic and may be accompanied by other neurologic signs. Because the downward pull on neural structures can involve cranial nerves, these headaches can be associated with neurologic deficits such as diplopia from a CN VI palsy or other subtle neurologic signs. This makes the statement about possible neurologic deficits true.

The other points aren’t as consistent: onset is not usually immediate and often occurs within hours to a couple of days; relief after an epidural blood patch is typically rapid, not reliably delayed to 8–12 hours; and the claim about frequency in pregnant versus nonpregnant patients isn’t a defining, universally true rule for PDPH.