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Post Lumbar Puncture Headache

Post-Dural Puncture Headache


Presentation

  • Here we present a case of PDPH treated with sequential EBPs that resulted in delayed radicular pain. CASE REPORT: A 29-year-old female presented to the emergency room with a severe frontal headache of several days duration.[ncbi.nlm.nih.gov]
Asymptomatic
  • She was discharged the following day asymptomatic and remained asymptomatic at 3 days and 1 week later. Discussion The typical PDPH is frontal–occipital and may radiate to the neck or shoulders.[anesthesiology.pubs.asahq.org]
  • She has remained asymptomatic since then and has been receiving treatment with interferon-beta for multiple sclerosis.[ajnr.org]
Chronic Infection
  • Analysis of CSF is essential to identify secondary causes of dementia, preferentially chronic infections.[ncbi.nlm.nih.gov]
Tinnitus
  • Tinnitus is probably due to a cochlear dysfunction, and presents special characteristics.[ncbi.nlm.nih.gov]
  • Post Lumbar Puncture Headache Caffeine Taurate Magnesium Tinnitus the long-term course of migraine with aura (MA) has been poorly explored.[emergingindustries.eu]
Headache
  • Patients with headache performed a "Rising Manoeuvre" twice daily as long as the headache period lasted, and recorded pain and time variables.[ncbi.nlm.nih.gov]
Meningism
  • CONCLUSION: PLPH is related to increased Gd-DTPA enhancement of the meninges, although the increase in enhancement during PLPH is minor in most cases. Pronounced enhancement of the meninges after lumbar puncture may predict long duration of the PLPH.[ncbi.nlm.nih.gov]
  • It is enterovirus season – and with that comes viral (aseptic) meningitis. Now you may argue (correctly) that you don’t need to do an LP if your pre-test probability for bacterial meningitis is low.[pemcincinnati.com]
Excruciating Headache
  • But after 10 days of excruciating headaches and now 4 weeks later I have the same symptoms you described.[medhelp.org]
Dysesthesia
  • Burning sensation at the injection site and dysesthesia at the time of injection were noted in 3.5% and 7.1% of patients, respectively.[ncbi.nlm.nih.gov]
Cranial Nerve Involvement
  • She denied vomiting, photophobia, tinnitus, or symptoms of cranial nerve involvement. Physical examination and vital signs were within normal limits. A diagnosis of PDPH was made.[anesthesiology.pubs.asahq.org]

Treatment

  • PDPH 24 hours after treatment, classified on a 4-point scale (no, mild, moderate, severe) is the primary outcome. The secondary outcome is the presence of PDPH 7 days after treatment.[ncbi.nlm.nih.gov]
  • However, because the treatment of PDPH with cosyntropin is noninvasive and may be beneficial, we believe it should be considered in the treatment of PDPH.[anesthesiology.pubs.asahq.org]

Prognosis

  • In this setting, a trigger factor, such as an increase in systemic blood pressure, generates segmental vasogenic edema. 2, 4 Despite the good overall prognosis, this condition is not completely benign because of the potential for bleeding into the lesion[ajnr.org]
  • Part II: prevention, management, and prognosis. Headache 50:1482–1498 PubMed CrossRef Google Scholar 4. Ahmed SV, Jayawarna C, Jude E (2006) Post lumbar puncture headache: diagnosis and management.[link.springer.com]
  • Nordland Hospital Bodø Treatment and prognosis Post-dural puncture headache has in principle a self-limiting course.[tidsskriftet.no]
  • Bezov D, Ashina S, Lipton R (2010) Post-dural puncture headache: Part II--prevention, management, and prognosis. Headache 50: 1482-1498.[omicsonline.org]

Etiology

  • Two case reports are presented, followed by a review of the literature concerning etiology, diagnosis, and treatment of post-lumbar puncture headache.[ncbi.nlm.nih.gov]
  • Post-lumbar puncture headache: etiology and management. West J Med 1998 ; 148 : 551 -4. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 2003 ; 91 : 718 -29. Sudlow C, Warlow C.[emed.ie]
  • Post-dural puncture headache: Part I diagnosis, epidemiology, etiology and pathophysiology. Headache. 2010;50:1144-1152. PMID: 20533959 Hammond ER et al. Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic.[coreem.net]
  • Etiology and management. West J Med 1988;148(5):551-4. Casey WF. Post lumbar puncture headache. J R Soc Med 1982;75(9):752-3. Sharma R, Bailey A, Bamber J. Post-dural puncture headache. Br J Anaesth 2004;92(3):449-50. Lin W, Geiderman J.[acta.tums.ac.ir]
  • The etiology is unknown but it is thought that the lumbar puncture allows a small cerebrospinal fluid leak to occur causing intracranial hypotension, downward sagging of the brain and subsequent pulling on the pain sensitive meninges and large blood vessels[pediatriceducation.org]

Epidemiology

  • Post-dural puncture headache: Part I diagnosis, epidemiology, etiology and pathophysiology. Headache. 2010;50:1144-1152. PMID: 20533959 Hammond ER et al. Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic.[coreem.net]
  • : diagnosis and management (National Center for Biotechnology Information) Cerebrospinal fluid (CSF) (Encyclopà dia Britannica) Spinal headaches (Mayo Clinic) Lumbar puncture (spinal tap) (Mayo Clinic) Post-dural puncture headache: part I diagnosis, epidemiology[headacheandmigrainenews.com]
  • History and epidemiology First epidural blockade was reported by an American physician Dr. James Leonard Corning in 1885 [ 26 ]. The actual history of spinal anesthesia can be traced back to 1888 by German physician Dr.[intechopen.com]
Sex distribution
Age distribution

Pathophysiology

  • This article outlines the pathophysiology and incidence of headaches related to lumbar punctures in the pediatric oncology setting and reviews the evidence from research trials to suggest which interventions clinicians should adopt into their practice[ncbi.nlm.nih.gov]
  • : The pathophysiology leading to headache is thought to be persistent leakage of cerebral spinal fluid (CSF) from the puncture site causing low CSF pressure and volume ( Bezov 2010 ).[coreem.net]

Prevention

  • This narrative review explores the literature to determine strategies for preventing headache and provide evidence-based nursing care to adults with post-lumbar puncture headache.[ncbi.nlm.nih.gov]

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