It is thought to result from leakage of cerebrospinal fluid through the dura mater puncture hole and consecutively. Also known as postdural puncture headaches a 2018 meta analysis showed atraumatic needles had a lower incidence of post lp headache and need for blood patch when compared to sharp needles. Differential diagnosis of nonpdph following meningeal puncture. Effectiveness of epidural blood patch in the management of. What is the differential diagnosis for this patients headache. This feels similar to having the original epidural or spinal injection. The incidence of pdph following spinal anaesthesia is post dural puncture headache management headache is not an uncommon complaint during the postpartum period. Technique, timing and administration practice pamela flood, md stanford university sol shnider 2018. A 2003 metaanalysis described the onset of pdph as occurring from 1 to 7 days after the procedure.
The current authors present a case of severe upper back pain without headache after an accidental dural puncture, which required an epidural blood patch. However ebp has its own limitations and complicationsthe procedure is involved and requires collection of blood from the patient and injection of the blood into the epidural space. Epidural blood patch sprigge 1999 anaesthesia wiley. In most cases, onetwo patches are needed for successful management. Longterm effects of ebp on the incidence of backache, headache and early audiometric deterioration are few or nonexistant. Epidural blood patch for treatment of postdural puncture headache in a patient with spinal fusion and recent implantation of intrathecal pain pump. Guidelines for placement of epidural blood patch epidural blood patch is used to manage a persistent, incapacitating dural puncture headache.
Guidelines for the diagnosis, treatment and prevention of. Epidural blood patch for postdural puncture headache dr. Postdural puncture headache pdph postdural puncture headache pdph is a complication of puncture of the dura mater, performed for diagnostic or therapeutic purposes or accidentally, as a complication of epidural anesthesia. In cases 1 and 2, the patients received blood contaminated from the skin case 1 or a bacteraemia case 2. Post dural puncture headache pdph is a frequent complication of lumbar puncture, performed for diagnostic or therapeutic purposes or accidentally, as a complication of epidural anesthesia. Role of needle gauge and tip configuration in the production of lumbar puncture headache.
Aug 11, 2010 postdural puncture headache pdph has been a problem for patients, following dural puncture, since august bier reported the first case in 1898. Epidural analgesia in labour, complicated by an accidental dural puncture and a postdural puncture headache pdph occurs not uncommonly. Suspect pdph in all patients who recently underwent an lp or epidural anesthesia regardless of whether they meet the ihs criteria. Complications are uncommon and usually selflimiting. The headache is severe and described as searing and spreading like hot metal, involving the back and front of the head and spreading to the neck and shoulders, sometimes involving neck stiffness. Postdural puncture headache management headache is not an uncommon complaint during the postpartum period. Postpartum dural venous sinus thrombosis after postdural puncture headache and epidural blood patch you will receive an email whenever this article is corrected, updated, or cited in the literature. Post duralpuncture headache affects up to 30% of patients after lumbar puncture. Epidural blood patch for postdural puncture headache. The differential diagnosis of the headache and the possible relationship of the intracerebral haemorrhage to the dural puncture and the epidural blood patch are discussed.
Postdural puncture headache remains a prominent clinical concern to the present day. The epidural needle is placed in epidural space at the level where the spinal leakage is suspected. Headache occurring within 5 days of a lp, caused by csf leakage through the dural puncture. Epidural blood patch the high success rate 6890% after. The differential diagnosis of the headache and the possible relationship of the intracerebral haemorrhage to the dural puncture and the epidural blood patch are. Postpartum dural venous sinus thrombosis after postdural. Postduralpuncture headache pdph is a complication of puncture of the dura mater the. Epidural blood patch technique, recovery, and success rate. Epidural blood patching ebp remains the gold standard treatment of pdph. An audit of epidural blood patch after accidental dural puncture with. Consider the differences in etiology and treatment of pdph in adults as compared to children.
Postulated reasons for headache following dural tap include. This feels similar to having the original epidural or. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. This headache, called postdural puncture pdph, or lowpressure headache. Controversy still exists over when to perform an ebp, how much blood to inject, and how to manage patients postebp. Post dural puncture headache affects up to 30% of patients after lumbar puncture. The differential diagnosis of postpartum headache is extensive.
Describe how you would perform an epidural blood patch. Effectiveness of epidural blood patch in the management of postdural puncture headache. Jul 08, 2017 blood patch minor postdural puncture headache are treated with blood patch treatment. Epidural blood patch ebp has a high success rate and is often used to treat post dural puncture headache pdph. By which mechanism does the epidural blood patch cure headache. Postduralpuncture headache wikimili, the best wikipedia. Postdural puncture headaches pdph in pediatrics may present diagnostic and.
We believe this is the third patient of its kind described in the literature. Jan 12, 2012 since august bier reported the first case in 1898, post dural puncture headache pdph has been a problem for patients following dural puncture. The incidence of accidental dural puncture adp during labor epidural insertion is approximately 1. Blood patching should normally be performed only after the first 24 h, as prior to this it is associated with lower success rates. A post dural puncture headache can be treated with an epidural blood patch. The anaesthetist takes blood from your arm and injects it into your back, near to the hole in the dura. Discuss the indications and contraindications for an epidural blood patch in the pediatric. Guidelines for the management of post dural puncture headache by philip anderson 1 introduction 1. Differential diagnosis of post dural puncture headache in pregnant women 1. Various treatment modalities have been tried for postdural puncture headache pdph among which epidural blood patch ebp remains as the gold standard. These three cases demonstrate some of the complications of epidural blood patch. To patch or not to patch society for pediatric pain medicine. Guidelines for the management of post dural puncture headache. Worsening with upright position and relief with recumbency.
May 29, 2014 epidural blood patch ebp is a common method for treating postural headache in patients with accidental dural puncture. Systemic infection and fever, infection on the back. Epidural blood patch cures postdural puncture headache in 90% of cases d. Differential diagnosis pdph headache characteristics warranting. Use of less effective measures rather than epidural blood patch to treat the headache often.
Epidural blood patch cures post dural puncture headache in 90% of cases d. Twelve days after an uncomplicated labor epidural a patient was awakened by a crushing postural. Late postpartum eclampsia coincident with an ebp and caffeine has been previously reported. Persistent and severe pdph may require an epidural blood patch. You can manage this and all other alerts in my account. Case report a 39yrold, 92 kg, 170 cm man presented to our pain clinic with severe lumbar pain accompanied by radicular symptoms.
In obstetric patients, conservative and pharmacological management of postdural puncture headache pdph is often ineffective. His paper discussed the pathophysiology of lowpressure headache resulting from leakage of cerebrospinal fluid csf from the subarachnoid to the epidural space. Various conservative, pharmacological and interventional measures are available. The incidence of pdph following spinal anaesthesia is dural puncture 2. Postdural puncture headache advances in anesthesia. Can pharmacological methods reduce the symptoms of postdural puncture headache. Effectiveness of epidural blood patch in the management of postdural puncture headache you will receive an email whenever this article is corrected, updated, or cited in the literature. Review the epidemiology, etiology and diagnosis of post dural puncture headache pdph present risk factors for pdph. We describe a patient with an intracerebral haemorrhage following an accidental dural puncture during an attempted epidural for pain relief in labour. Practitioners of anesthesia are universally aware of postdural puncture headache pdph, yet our understanding of this serious complication remains surprisingly incomplete.
Post dural puncture headache pdph, also known as post lumbar puncture lp headache, is a common complication of diagnostic lp. Post dural puncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord. In cases 2 and 3, a differential diagnosis had to be made, to exclude meningitis. Complications of labor epidural anesthesia include a postdural puncture headache pdph. It is usually accompanied by neck stiffness andor subjective hearing symptoms. Since august bier reported the first case in 1898, postdural puncture headache pdph has been a problem for patients following dural puncture.
At 7 days, only 3 of 21 conservatively treated patients had fully recovered no headache symptoms versus 16 of 19 patients treated with ebp p epidural blood patch in post dural puncture headache. We present a case of a postpartum seizure after an ebp, without the administration. Presented here is the first published case of a pdph occurring 12 days postpartum. Epidural blood patch and late postpartum eclampsia. It is thought to result from leakage of cerebrospinal fluid through the dura mater puncture hole and consecutively reduced fluid levels in the brain and spinal cord. Clinical and laboratory research over the last 30 years has shown that use of smallergauge needles, particularly. Epidural blood patch in postdural puncture headache. Controversy still exists over when to perform an ebp, how much blood to inject, and how to manage patients post ebp. Anaesthetists need to include intracerebral haemorrhage in the differential diagnosis of post dural puncture headache in the puerperium. Epidural saline, dextran, opioids, tissue glue are also been used to reduce rate of csf loss.
Epidural analgesia in labour, complicated by an accidental dural puncture and a post dural puncture headache pdph occurs not uncommonly. In obstetric patients, conservative and pharmacological management of post dural puncture headache pdph is often ineffective. Longterm effects of accidental dural puncture in patients. Discuss epidural blood patch as treatment of pdph in children. Post dural puncture headache management headache is not an uncommon complaint during the postpartum period. An uneventful autologous epidural blood patch was performed after failure of initial conservative management, and the patient had immediate relief of her headache. It remits spontaneously within two weeks, or after sealing of the leak with epidural blood patch.