MSFinals-3142

MSFinals-3142

A 36-year-old man is discharged from hospital after an episode of meningitis. The organism was diagnosed as being Streptococcus pneumoniae after a lumbar puncture and the patient was treated with ceftriaxone. On discharge, his observations were normal. He has a past medical history of asthma treated with salbutamol and low-dose inhaled corticosteroids. He has no known drug allergies.
A few days following his discharge, he started experiencing postural headaches that were worse when sitting upright. He grades his pain as 7/10. He has been feeling nauseated, although has had no vomiting episodes. He also has some minor neck stiffness and is not confused. He attends A&E, as he is worried about his new symptoms. There is evidence of extrathecal cerebrospinal fluid (CSF). Diagnosis is confirmed on a computed tomography (CT) myelogram.
What is the most likely cause of this patient’s headache?