Mechanisms behind postspinal headache and brain stem compression following lumbar dural puncture – a physiological approach

Abstract

Mechanisms behind postspinal headache and brain stem compression following lumbar dural puncture -a physiological approach.Grände, Per-Olof 619-626. DOI: 10.1111619-626. DOI: 10. /j.1399619-626. DOI: 10. -6576.2004 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Methods: Hydrostatic effects of distal opening of the dural sac towards the atmosphere are described and applied to the normal brain and the brain with disrupted BBB. Analogue analyses from an isolated skeletal muscle enclosed in a rigid shell were applied to the brain in an attempt to simulate and verify haemodynamic effects of distal opening of the spinal canal. Results Conclusion:The present study strongly suggest that post-spinal headache and brain stem compression and other LP-related effects are predictable following LP, without involving CSF leakage, and can be explained by hydrostatic effects triggered by distal opening of the normally closed dural space to the atmosphere.

Jugular venous pooling during lowering of the head affects blood pressure of the anesthetized giraffe

“…Although these mechanisms warrant further evaluation, we suggest that the reduction in MAP decreased the rise in blood pressure at the level of the head and, thereby, contributed to protecting brain capillaries when the head is lowered. Furthermore, subdural venous collapse (17), along with the increase in spinal fluid pressure when lowering the head, may act to protect the cerebral vasculature by decreasing the pressure difference between the capillary blood and spinal fluid.…”

Multimodal cerebral monitoring and decompressive surgery for the treatment of severe bacterial meningitis with increased intracranial pressure

“…Finally, even if there was no focal sign, performing a lumbar puncture before obtaining brain imaging is controversial (12,16). Although lumbar puncture remained crucial for diagnosis and adequate antibiotherapy, it might have triggered brain stem herniations, particularly in the state of a disrupted blood–brain barrier as previously described (12,16,17). Nevertheless, this case report pointed to the fact that lumbar puncture may be hazardous.…”

Evaluation of Affecting Factors and The Effectiveness of Treatment in Cases With Post-Dural Puncture Headache Who Underwent Epidural Blood Patch

“…72% of cases ceases in 7 days and 87% of cases in 6 months spontaneously. [12,13] In our study patients referred to our clinic ceased on average 3 days.…”

“…In some cases tinnitus, vertigo, nausea-vomiting, photophobia, neck stiffness can be seen. [2,11] Differential diagnosis of PDPH includes other clinical manifestations like nonspecific headache, caffeine withdrawal syndrome, migraine, menengitidis, sinusitis, pre-eclampsia, intracranial pathologies [1,13] and they are eliminated before EBP in our clinic.…”