Postdural/archnoid puncture headache / Reply to Dr. Glazener

To the Editor:

The study of Reina et al.1 is an interesting attempt to understand the mechanism of postdural puncture headache (PDPH). However, the role of the arachnoid layer, which is a distinct layer, has inappropriately been ignored. For instance, when performing a spinal anesthetic, a free flow of fluid midway during the injection does not rule out the possibility that the potential space between the dura and the arachnoid has become an actual space containing some of the anesthetic agent. Radiologists are much more aware of this outcome because they can see the contrast medium…