{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:14:23Z","timestamp":1790702063369,"version":"4.1.0"},"reference-count":3,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T00:00:00Z","timestamp":1740182400000},"content-version":"vor","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,22]]},"abstract":"Abstract<\/jats:title>\n Background and Importance: Post-dural puncture headache (PDPH) is a well-recognized and frequently encountered complaint of Lumbar puncture. It usually resolves spontaneously over two weeks or with an epidural blood patch. Although known for a long time, PPDH could be linked to an arachnoidal bleb as a cause of cerebrospinal fluid (CSF) leakage. We report on surgical findings and impressive findings with low-flow CSF leakage in the context of an arachnoidal bleb.<\/jats:p>\n Clinical presentation: We report a 42-year-old Neuroscientist with a 23-month history of positional headaches after a lumbar puncture (LP). Multiple Sclerosis was ruled out, but chronic orthostatic headache and tinnitus developed. Bed rest, caffeine tablets, IV hydration, and five high-volume epidural blood patches did not lead to improvement. However, brain fog and reduced ability to work ensued. A dynamic myelography did not reveal a CSF leak or a CSF-venous fistula, but a high-resolution T2Space Fat-saturated MRI detected an arachnoidal bleb at the alleged L3-L4 level.<\/jats:p>\n Microsurgical exploration identified the arachnoid bleb as a low-flow CSF leak. The video depicts Neomenbranes overlaying the dura mater appearing as a web and CSF oozing, washing a layer of blood away. CSF was leaking like a tear, and we had the impression of a weeping dura. Treatment involved bipolar shrinking, reinforcement of the dura and fibrin glue. The patient\u2019s symptoms improved slowly post-surgery.<\/jats:p>\n Conclusion: This case emphasises the importance of considering atypical causes of post-lumbar puncture complications, such as arachnoid blebs, and the role of surgery in identifying and treating these rare conditions.<\/jats:p>","DOI":"10.1093\/omcr\/omae182","type":"journal-article","created":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T06:26:51Z","timestamp":1740205611000},"source":"Crossref","is-referenced-by-count":6,"title":["An arachnoid bleb and weeping dura\u2014a persistent low flow CSF-leak after lumbar puncture"],"prefix":"10.1093","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8250-5883","authenticated-orcid":false,"given":"Amir","family":"El Rahal","sequence":"first","affiliation":[{"name":"Medical Center University of Freiburg , Breisacher strasse 64, 19106 Freiburg im Breisgau,","place":["Germany"]},{"name":"Faculty of Medicine, University of Geneva , Rue Michel Servet 1, 1206 Geneva,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Wolf","sequence":"additional","affiliation":[{"name":"Medical Center University of Freiburg , Breisacher strasse 64, 19106 Freiburg im Breisgau,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Volz","sequence":"additional","affiliation":[{"name":"Medical Center University of Freiburg , Breisacher strasse 64, 19106 Freiburg im Breisgau,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Beck","sequence":"additional","affiliation":[{"name":"Medical Center University of Freiburg , Breisacher strasse 64, 19106 Freiburg im Breisgau,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,22]]},"reference":[{"key":"2025022206255500900_ref1","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1136\/pgmj.2006.044792","article-title":"Post lumbar puncture headache: diagnosis and management","volume":"82","author":"Ahmed","year":"2006","journal-title":"Postgrad Med J"},{"key":"2025022206255500900_ref2","doi-asserted-by":"publisher","first-page":"1350","DOI":"10.1001\/jama.1918.02600190006002","article-title":"The cause of lumbar puncture headache. JAMA: the","volume":"70","author":"Mac Robert","year":"1918","journal-title":"JAMA J Am Med Assoc"},{"key":"2025022206255500900_ref3","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.clinimag.2021.08.023","article-title":"Post-dural puncture pseudomeningocele (\u201carachnoid bleb\u201d): an underrecognized etiology of spontaneous intracranial hypotension symptomatology","volume":"80","author":"Roytman","year":"2021","journal-title":"Clin Imaging"}],"container-title":["Oxford Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/omcr\/article-pdf\/2025\/2\/omae182\/62049689\/omae182.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/omcr\/article-pdf\/2025\/2\/omae182\/62049689\/omae182.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T06:26:53Z","timestamp":1740205613000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/omcr\/article\/doi\/10.1093\/omcr\/omae182\/8029942"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":3,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,2,22]]}},"URL":"https:\/\/doi.org\/10.1093\/omcr\/omae182","relation":{},"ISSN":["2053-8855"],"issn-type":[{"value":"2053-8855","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,2]]},"published":{"date-parts":[[2025,2]]},"article-number":"omae182"}}