Hypotension and transient renal impairment induced by lumbar puncture

Introduction: Raised intracranial pressure (ICP) may induce hypertension through sympathetic mechanisms. Methods: Case report. Results: A 55-year-old man was admitted with a symptomatic intracerebral mass and new refractory arterial hypertension. Several antihypertensive medications were necessary to control his blood pressure. A lumbar puncture was performed for diagnostic purposes and raised opening pressure (42 cm H2O) denoted raised ICP. After cerebrospinal fluid extraction, the closing pressure dropped to normal level. Shortly after the lumbar puncture, a sudden and pronounced drop in blood pressure was noted. Over the next day, the patient's serum creatinine rose from 0.9 to 1.9 mg/dL. Blood pressure normalized after discontinuation of all antihypertensive drugs and administration of intravenous fluids. Renal function also completely recovered within 2 days. The patient remained spontaneously normotensive thereafter. Conclusion: Sudden hypotension may occur after lumbar puncture in patients with raised ICP receiving treatment for arterial hypertension.