Headache and Neurological Symptoms Following Lumbar Puncture in a Patient With a Ventriculoperitoneal Shunt.

Post-dural puncture headache (PDPH) is a common complication of lumbar puncture and neuraxial anesthesia, typically resulting from cerebrospinal fluid (CSF) leakage and intracranial hypotension. Although the pathophysiology and management of PDPH are well established in the general population, its diagnosis and treatment in patients with ventriculoperitoneal shunts pose unique challenges due to altered CSF dynamics and intracranial compliance. In these individuals, even minor CSF volume changes can produce unpredictable pressure gradients and paradoxical phenomena such as low-pressure hydrocephalus. The use of an epidural blood patch, a mainstay of PDPH management, carries additional risks in this population and must be approached with multidisciplinary collaboration and careful hemodynamic consideration.