scholarly journals Headache and nuchal rigidity and photophobia after an epidural blood patch: diagnosis by exclusion of persistent post-dural puncture headache mimicking meningitis

2010 ◽  
Vol 105 (6) ◽  
pp. 871-873 ◽  
Author(s):  
G Kanazi ◽  
F Abdallah ◽  
A Dabbous ◽  
S Atweh ◽  
M El-Khatib
Keyword(s):  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Post Dural Puncture Headache ◽  
Nuchal Rigidity ◽  
Diagnosis By Exclusion ◽  
Blood Patch

scholarly journals Comparisons of clinical characteristics, brain MRI findings, and responses to epidural blood patch between spontaneous intracranial hypotension and post-dural puncture headache: retrospective study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gha-Hyun Lee ◽  
Jiyoung Kim ◽  
Hyun-Woo Kim ◽  
Jae Wook Cho
Keyword(s):  
Intracranial Hypotension ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Brain Mri ◽  
Spontaneous Intracranial Hypotension ◽  
Vein Of Galen ◽  
Mri Findings ◽  
Post Dural Puncture Headache ◽  
Straight Sinus ◽  
Blood Patch

Abstract Background Spontaneous intracranial hypotension and post-dural puncture headache are both caused by a loss of cerebrospinal fluid but present with different pathogeneses. We compared these two conditions concerning their clinical characteristics, brain imaging findings, and responses to epidural blood patch treatment. Methods We retrospectively reviewed the records of patients with intracranial hypotension admitted to the Neurology ward of the Pusan National University Hospital between January 1, 2011, and December 31, 2019, and collected information regarding age, sex, disease duration, hospital course, headache intensity, time to the appearance of a headache after sitting, associated phenomena (nausea, vomiting, auditory symptoms, dizziness), number of epidural blood patch treatments, and prognosis. The brain MRI signs of intracranial hypotension were recorded, including three qualitative signs (diffuse pachymeningeal enhancement, venous distention of the lateral sinus, subdural fluid collection), and six quantitative signs (pituitary height, suprasellar cistern, prepontine cistern, mamillopontine distance, the midbrain-pons angle, and the angle between the vein of Galen and the straight sinus). Results A total of 105 patients (61 spontaneous intracranial hypotension patients and 44 post-dural puncture headache patients) who met the inclusion criteria were reviewed. More patients with spontaneous intracranial hypotension required epidural blood patch treatment than those with post-dural puncture headache (70.5% (43/61) vs. 45.5% (20/44); p = 0.01) and the spontaneous intracranial hypotension group included a higher proportion of patients who underwent epidural blood patch treatment more than once (37.7% (23/61) vs. 13.6% (6/44); p = 0.007). Brain MRI showed signs of intracranial hypotension in both groups, although the angle between the vein of Galen and the straight sinus was greater in the post-dural puncture headache group (median [95% Confidence Interval]: 85° [68°-79°] vs. 74° [76°-96°], p = 0.02). Conclusions Patients with spontaneous intracranial hypotension received more epidural blood patch treatments and more often needed multiple epidural blood patch treatments. Although both groups showed similar brain MRI findings, the angle between the vein of Galen and the straight sinus differed significantly between the groups.

Post–Dural Puncture Headache

2017 ◽  
Author(s):  
Philip Rubin
Keyword(s):  
Cerebrospinal Fluid ◽  
Epidural Space ◽  
Gold Standard ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Caffeine Intake ◽  
Recumbent Position ◽  
Post Dural Puncture Headache ◽  
Blood Patch

Post–dural puncture headache (PDPH) is a benign but debilitating condition that may occur as a consequence of any dural puncture, whether intentional (as with spinal anesthesia or lumbar puncture) or inadvertent (as with epidural anesthesia). The headache is characteristically unique, as it is postural in nature—worsened when sitting or standing, and markedly improved in the recumbent position. After the puncture, passage of cerebrospinal fluid (CSF) across the dura mater from a pressurized environment (subarachnoid space) to the epidural space, is the initial culprit behind the headache. Noninvasive conservative measures including hydration, analgesics, and caffeine intake are typically offered as initial treatments, but if those measures fail, the “gold standard” epidural blood patch is commonly offered. This procedure entails injection of autologous blood into the epidural space to both halt continued CSF “loss,” and to increase CSF pressure, both of which aid in headache resolution.

Epidural Blood Patch

2018 ◽  
Author(s):  
Kenneth D. Candido ◽  
Teresa M. Kusper ◽  
Bora Dinc ◽  
Nebojsa Nick Knezevic
Keyword(s):  
Drug Delivery Systems ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Post Dural Puncture Headache ◽  
Blood Patch ◽  
Csf Leakage ◽  
Pressure Dynamics ◽  
Diagnostic Lumbar Puncture ◽  
Low Pressure Headache ◽  
Pressure Headache

Post-dural-puncture headache (PDPH) is a consequence of neuraxial anesthesia, diagnostic lumbar puncture, intrathecal drug delivery systems, or any other technique involving dural trespass. The spinal headache results from a dural puncture that leads to cerebrospinal fluid (CSF) leakage from the subarachnoid space to the epidural space, culminating in intracranial hypotension and development of a low-pressure headache. A key element of PDPH is an increase in pain severity upon a change in position from supine to upright, which corresponds to a gravity-induced influence on CSF pressure dynamics. Age, sex, and design of the needle used correlate with the risk of headache. Sometimes, the headache resolves spontaneously. At other times, conservative treatment or aggressive measures are required to terminate the pain. An autologous epidural blood patch is an established way preventing or treating PDPH. A careful history must be obtained to identify other causes of headache before the blood patch is attempted.

Treatment of obstetric post-dural puncture headache. Part 2: epidural blood patch

2019 ◽  
Vol 38 ◽  
pp. 104-118 ◽  
Author(s):  
R. Russell ◽  
C. Laxton ◽  
D.N. Lucas ◽  
J. Niewiarowski ◽  
M. Scrutton ◽  
...  
Keyword(s):  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Post Dural Puncture Headache ◽  
Blood Patch
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