Which of the following factors should be avoided in patients with cranial CSF leaks?

Avoiding activities that increase intracranial pressure is critical in managing patients with cranial cerebrospinal fluid (CSF) leaks. Coughing can significantly elevate intracranial pressure, which may worsen the leak or impede its healing. The act of coughing puts strain on the cranial cavity, potentially exacerbating any current leaks or creating new ones.

Other factors, such as hydration and bed rest, are generally encouraged in patients with cranial CSF leaks. Adequate hydration helps maintain optimal intracranial pressure and can promote healing, whereas bed rest can help to minimize movements that might compromise the repair of the leak or contribute to further leaks. IV caffeine infusions are sometimes used to treat post-dural puncture headaches, and while the justification for their use is specific, they do not inherently increase the risk of complicating a CSF leak. Hence, avoiding coughing stands out as the most critical factor in the management of patients with cranial CSF leaks.