Low cerebrospinal fluid volume and the risk for post-lumbar puncture headaches

Amgad Droby, Nurit Omer, Tanya Gurevich, Meir Kestenbaum, Yair Mina, Jesse M. Cedarbaum, Orna Aizenstein, Nir Giladi, Anat Mirelman, Avner Thaler*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Article number117059
JournalJournal of the Neurological Sciences
StatePublished - 15 Oct 2020


FundersFunder number
Abbvie- Israel
European Union 7th Framework Program
Intec Pharma
Israeli Innovation Authority
Sagol School of Neuroscience
Michael J. Fox Foundation for Parkinson's Research16137
National Parkinson Foundation
Teva Pharmaceutical Industries
International Parkinson and Movement Disorder Society
Seventh Framework Programme
Parkinson's Foundation
Israel Science Foundation
Sagol School of Neuroscience, Tel Aviv University


    • CSF volume
    • MRI
    • Post LP headaches


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