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CSF leak 3 weeks after LP
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CSF leak 3 weeks after LP

My girlfriend (42y/o) was dx'd w viral meningitis by LP.  After about a week the HA changed from neck/occiput area to top of head 10/10 pain.  Cont'd w nausea/dizzyness/pain despite meds.  Came off of Perc thinking narc HA.  Vomitting came back full force then went back to ED.  Was 3 weeks into this w no turn around.  Repeat CT/MRI showed some cerebral edema but no other abnormalities.  Finally, a 2nd anesthesiologist agreed to do blood patch.  She declined 2nd LP until attempting this.  Within few hour she was able to stand up and eat thank goodness.  How common is it to have CSF leak this length of time after LP (3weeks)?  She has lupus but very rarely has any signs of it. Could this have affected the epidural site healing?  Why is there a hesitancy to do a blood patch right away as a preventative after an LP?
Tags: CSF leak
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Avatar_dr_m_tn
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I cannot tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

I am glad that your girlfriend's condition improved after the blood patch.  It is rare but not impossible for a CSF leak to persist so long after the lumbar puncture.  Most patients have resolution of their CSF leak, and related symptoms within the first 48 hrs.  I am unaware of any evidence that a condition such as lupus would have played a role in delaying healing at the site of the leak.  

Although I cannot speak to the timing of the blood patch in your girlfriend's case, there is a small risk of complications associated with the blood patch procedure including risk of infection or bleeding.  A physician may decide to pursue conservative management with IV fluids, caffeine administration, and additional time for healing before going directly to the blood patch option.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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