Post-dural-puncture headache

Post-dural-puncture headache
Post-dural-puncture headache
Classification and external resources
ICD-10 G44.820, G97.0
ICD-9 349.0
MeSH D051299

Post-dural-puncture headache (PDPH) is a complication of puncture of the dura mater (one of the meninges that surround the brain and spinal cord).[1] This occurs in spinal anesthesia and lumbar puncture and may, accidentally, occur in epidural anesthesia.

Contents

Presentation and pathophysiology

PDPH typically occurs hours to days after puncture and presents with symptoms such as headache and nausea that typically worsen when the patient assumes an upright posture.

It is thought to result from a loss of cerebrospinal fluid[1] into the epidural space. A decreased hydrostatic pressure in the subarachnoid space then leads to traction to the meninges with associated symptoms.

The incidence of PDPH is higher with younger patients, complicated or repeated puncture, and use of large diameter needles. Modern, atraumatic needles such as the Sprotte spinal needle leave a smaller perforation and reduce the risk for PDPH.

Treatment

Some patients require no other treatment than analgesics, caffeine, and bed rest. Other patients might need triptan.

However, persistent and severe PDPH may require an epidural blood patch. A small amount of the patient's blood is injected into the epidural space near the site of the original puncture; the resulting blood clot then "patches" the meningeal leak. The procedure carries the typical risks of any epidural puncture. However, it is effective,[2] and further intervention is rarely necessary.

Prevention

The conventional medical wisdom over the last several decades for avoiding PDPH has been to use smaller gauge or modern needles which traumatize the dura less or make a smaller dura puncture, thereby lessening CSF leakage that causes PDPH. While these approaches have been effective at lowering PDPH rates, they have been unsuccessful at completely preventing PDPH. There is evidence that a more effective preventative approach is to make a self-closing puncture in the dura, using a simple beveled needle with a specific angle and bevel orientation. [3] This approach can also prevent PDPH headaches caused by over-penetration during epidural anesthesia (where dural puncture was never intended), since withdrawal of the needle allows the dural puncture to self-close.

References

  1. ^ a b Turnbull DK, Shepherd DB (November 2003). "Post-dural puncture headache: pathogenesis, prevention and treatment". Br J Anaesth 91 (5): 718–29. doi:10.1093/bja/aeg231. PMID 14570796. http://bja.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=14570796. 
  2. ^ Safa-Tisseront V, Thormann F, Malassiné P, et al. (August 2001). "Effectiveness of epidural blood patch in the management of post-dural puncture headache". Anesthesiology 95 (2): 334–9. PMID 11506102. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0003-3022&volume=95&issue=2&spage=334. 
  3. ^ Bela I. Hatfalvi, M.D. (July-August 1995). "Postulated Mechanisms for Post Dural Puncture Headache: Clinical Experience and Review Of Laboratory Models". Regional Anesthesia 20 (4): 329–336. 



Wikimedia Foundation. 2010.

Игры ⚽ Нужен реферат?

Look at other dictionaries:

  • Post dural puncture headache — (PDPH), or low Cerebralspinal Fluid (CSF) pressure headache is a complication of spinal anesthesia, diagnostic spinal puncture, or epidural anesthesia. It can sometimes also happen as a result of a severe physical trauma involving the spine, or… …   Wikipedia

  • Headache attributed to a substance or its withdrawal — Classification and external resources ICD 9 339.3 Headaches can be attributed to many different substances. Some of these include alcohol, NO, carbon monoxide poisoning, cocaine, and MSG. Chronic …   Wikipedia

  • Headache — For other uses, see Headache (disambiguation). Headache A person with a headache. ICD 10 G43 G …   Wikipedia

  • New daily persistent headache — Since 2004, New Daily Persistent Headache (NDPH) has been recognized as a distinct primary headache syndrome. It is classified as a Primary Headache Disorder by the ICHD 2 classification system (by the IHS) using number 4.8. Primary headache… …   Wikipedia

  • Syndrome post PL — Syndrome post ponction lombaire La ponction lombaire est un geste invasif qui se complique fréquemment de céphalées, parfois très sévères et invalidantes. Le syndrome post ponction lombaire, survenant après la réalisation d une ponction lombaire …   Wikipédia en Français

  • Syndrome post pl — Syndrome post ponction lombaire La ponction lombaire est un geste invasif qui se complique fréquemment de céphalées, parfois très sévères et invalidantes. Le syndrome post ponction lombaire, survenant après la réalisation d une ponction lombaire …   Wikipédia en Français

  • Syndrome post-ponction lombaire — La ponction lombaire est un geste invasif qui se complique fréquemment de céphalées, parfois très sévères et invalidantes. Le syndrome post ponction lombaire, survenant après la réalisation d une ponction lombaire, se présente sous la forme de… …   Wikipédia en Français

  • Medication overuse headache — Classification and external resources ICD 10 G44.41, G44.83 Medication overuse headaches (MOH) , also known as rebound headaches usually occur when analgesics are taken frequently to relieve headaches. Rebound headaches frequently occur daily and …   Wikipedia

  • Cluster headache — Classification and external resources The Cluster Headache by JD Fletcher ICD 10 G44 …   Wikipedia

  • Tension headache — Classification and external resources ICD 10 G44.2 ICD 9 307.81 …   Wikipedia

Share the article and excerpts

Direct link
Do a right-click on the link above
and select “Copy Link”