Post Dural Puncture Headache

Post Lumbal Puncture Headache

1. Post Dural Puncture headache Ade Wijaya, MD – September 2018

2. Outline: Introduction Risk factors Clinical course Treatment Summary

3. Introduction First reported by August Bier at 1898 C omplications of neuroaxial block or diagnostic lumbar puncture Incidence: 0,16 % - 3 % CSF leakage  decrease of intracranial pressure causing arteriolar and venous dilatation of cerebral vessels; distension on pain sensitive structure in cranium Erturk E, Kutanis D. Post Dural Puncture Headache. Int J Anesth Res. 2016 Nov 21;4(11):348-51.

4. Risk Factors PDPH incidence is higher especially in young female patients due to increased fiber elasticity of dura mater Increased BMI are related to lower incidence of PDPH. Higher intraabdominal pressure leads to increased pressure on dependent epidural vein. Thus, this event causes a protection to CSF leakage through dural puncture Former PDPH history Migraine and Similar Headache Experience of Practitioner Needle characteristic Erturk E, Kutanis D. Post Dural Puncture Headache. Int J Anesth Res. 2016 Nov 21;4(11):348-51.

5. Clinic Course of PDPH G enerally occurred in a week after the intervention. A n obtuse pain in localized generally frontal and occipital region of the head. Nausea, vomiting, visual and aural disorders, dizziness and neck stiffness may accompany. Symptoms are generally disappeared within two weeks . The headache typically worsens within the 15 min of assuming the upright position, improves within 30 min of resuming the recumbent position Evans RW, Armon C, Frohman EM, Goodin DS (2000) Assessment : prevention of post-lumbar puncture headaches: report of the therapeutics and technology assessment subcommittee of the american academy of neurology . Neurology . 55(7): 909-914 Porhomayon J, Zadeii G, Yarahamadi A, Nader ND (2013) A case of prolonged delayed postdural puncture headache in a patient with multiple sclerosis exacerbated by air travel. Case Rep Anesthesiol. 2013: 253218.

6. treatment Bedrest Crystalloid and Colloid Fluid Treatment Caffeine and Sumatriptan Epidural Blood Patch ( EBP ) Epidural Fluid Treatment

7. Summary O ne of the most frequently complication of the neuroaxial intervention. PDPH should be recognized, monitored, and treated.

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