Post-dural puncture headache

Buddeberg, B; Bandschapp, Oliver; Girard, Thierry

doi:10.23736/s0375-9393.18.13331-1

Cited by 46 publications

(83 citation statements)

References 73 publications

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“…Incidence. The occurrence of accidental dural puncture (ADP) during neuraxial anesthesia reported in the literature is relatively small -0,1 -1,5% [6,7] [4]. Costa et al [5] conducted a ten-year retrospective analysis of women, who received neuraxial anesthetic for labor and delivery.…”

Section: Resultsmentioning

confidence: 99%

Risk Factors, Clinical Manifestation and Prevention of Post-Dural Puncture Headache in the Obstetric Field

Kalinauskas¹,

Juotkutė²

2021

Health Sciences

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Introduction: Over the past decades, the number of women choosing to have epidural analgesia or undergoing spinal anesthesia during labor is steadily increasing. Consequently, a risk for complications is increasing. Post-dural puncture headache (PDPH) is considered one of the most common complication following accidental dural puncture (ADP). Sources and a method: A literature overview were conducted via search engine “PubMed (Medline)” and “Google Scholar”. Randomized controlled trials, meta – analysis, retrospective, prospective trials and systemic reviews on PDPH were selected. Aim of the review: To evaluate the most commonly described risk factors, clinical presentation and prevention of PDPH in the obstetric field. Results: The occurrence of ADP during neuraxial anesthesia reported in the literature is relatively small – 0,1 – 1,5%. PDPH is a potentially expected complication after any lumbar punction. It presents as a headache within five days of the puncture due to low cerebrospinal fluid pressure. The pain is often bilateral, located in the frontal or occipital areas. Symptoms, such as vision and hearing impairment, neck pain and nausea might follow. Usually, the symptoms fade out spontaneously within two weeks. Risk factors for PDPH are modifiable (technique of the injection and anesthesiologist’s skills) and non-modifiable (pregnancy, low body mass index (BMI), dehydration, history of PDPH). The goal of preventing PDPH is to identify and correct the risk factors associated with this condition. Main described means being equipment and experience, conservative measures, administration of epidural morphine, intravenous dexamethasone or cosyntropin, epidural blood patch and intrathecal catheter. Conclusions: 1. PDPH manifests as an orthostatic headache with or without ocular, neural, hearing and other symptoms. 2. Young pregnant women with low BMI are more likely to suffer from PDPH. 3. PDPH prevention consists of risk factor correction and proper medical techniques.

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Section: Resultsmentioning

confidence: 99%

Risk Factors, Clinical Manifestation and Prevention of Post-Dural Puncture Headache in the Obstetric Field

Kalinauskas¹,

Juotkutė²

2021

Health Sciences

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“…PDPHs can be extremely debilitating. A therapeutic blood patch is the only treatment with enough evidence to recommend its routine use for severe cases of PDPH 12 . The diagnosis of PDPH is made clinically, although imaging features can sometimes help in confirmation.…”

Section: Discussionmentioning

confidence: 99%

Epidural Contrast Volume on Post‐Myelogram Lumbar CT Predicts the Rate of Subsequent Blood Patch Treatment

Yu¹,

Kale

Branstetter

et al. 2021

Journal of Neuroimaging

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Background and Purpose Headaches due to cerebrospinal fluid (CSF) leakage are a well‐known complication of dural puncture. The purpose of this study was to determine whether the presence and volume of epidural contrast on postmyelogram CTs of the lumbar spine were associated with post‐dural puncture headaches (PDPHs) requiring epidural blood patch (EBP) treatment. Methods A retrospective case control study of all fluoroscopically guided lumbar myelograms performed over a 5‐year period by a single radiology practitioner assistant was performed. Ten patients who underwent EBP treatment after their myelograms were identified. Forty‐six patients with similar demographics who did not receive blood patches were then selected. CT‐lumbar myelogram images of patients and controls were reviewed. The volume of epidural contrast was then quantified as “severe” or “mild.” Severe epidural contrast was defined as contrast detected in the ventral epidural space, the extra‐foraminal space, or extending greater than or equal to the length of two vertebral bodies from the level of dural puncture. Results Some amount of epidural contrast was seen in all patients. However, a severe volume of epidural contrast was associated with increased risk for PDPH requiring an EBP (odds ratio = 37.00; 95% CI = 4.1–330.8, p = 0.0012). Conclusion Severe epidural contrast on postmyelogram CTs of the lumbar spine was associated with an increased risk of PDPH requiring EBP treatment. When present, this finding can alert the proceduralist that the patient may require closer observation and follow up with earlier intervention.

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“…or in patients who present with spontaneous intracranial hypotension. 13,14 EBP is a procedure in which a small volume of the patient's own blood is injected into the epidural space in an attempt to "plug" any small dural openings. In recent years, attempts have been made to expand the applicability of EBP.…”

Section: Epidural Blood Patchmentioning

confidence: 99%

Advances in the Management of Spinal Durotomy

Karnati¹,

Kulubya²,

Kim³

2020

MRAJ

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Spinal durotomy, whether incidental or intentional, requires a watertight closure to prevent potentially significant complications. As a result of relatively recent technological advancements and research, spine surgeons now have many options for both intra-operative dural repair as well as managing post-operative cerebrospinal fluid (CSF) leak. This review presents a comprehensive overview of the current and historical treatment strategies in the management of spinal durotomy.Intra-operative treatment of intentional and incidental durotomies through a variety of available dural sutures, dural sealants and other patches and grafts as well as post-operative CSF leak management strategies including conservative measures, epidural blood patches, CSF diversion therapies and definitive surgical repair will be presented.

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Post-dural puncture headache

Cited by 46 publications

References 73 publications

Risk Factors, Clinical Manifestation and Prevention of Post-Dural Puncture Headache in the Obstetric Field

Risk Factors, Clinical Manifestation and Prevention of Post-Dural Puncture Headache in the Obstetric Field

Epidural Contrast Volume on Post‐Myelogram Lumbar CT Predicts the Rate of Subsequent Blood Patch Treatment

Advances in the Management of Spinal Durotomy

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