scholarly journals Pneumocephalus as a Cause for Headache

2002 ◽  
Vol 29 (3) ◽  
pp. 278-281 ◽  
Author(s):  
W.J. Becker
Keyword(s):  
Lumbar Puncture ◽  
Dural Puncture ◽  
Abrupt Onset ◽  
Severe Headache ◽  
Clinical Settings ◽  
Puncture Site ◽  
Loss Of Resistance ◽  
Blood Patch ◽  
Brain Ct Scan

Background:Pneumocephalus can be a cause of headache, but is easily overlooked in some clinical circumstances.Case Study:A 35-year-old woman developed severe headache of abrupt onset during an epidural blood patch procedure done for a post-lumbar puncture headache. A brain CT scan showed subarachnoid air even though there was no evidence of a dural puncture having occurred during the procedure.Results:The experience of our patient, and a review of the literature suggests that air injected into the epidural space during use of the “loss of resistance” technique can enter the subarachnoid space if a dural puncture site from a previous lumbar puncture is present.Conclusion:Pneumocephalus should be considered as a potential cause for a severe headache occurring in association with epidural procedures, and also in a number of other clinical settings. Use of a high inspired air oxygen concentration can hasten absorption of an intracranial air collection.

scholarly journals The Management of Headache following Accidental Dural Puncture in Obstetric Patients

1983 ◽  
Vol 11 (1) ◽  
pp. 4-15 ◽  
Author(s):  
Peter Brownridge
Keyword(s):  
Dural Puncture ◽  
Autologous Blood ◽  
Radicular Pain ◽  
Severe Headache ◽  
Pressure Differential ◽  
Epidural Infusion ◽  
Puncture Site ◽  
Blood Patch ◽  
Accidental Dural Puncture

The progress and management of fifty-eight obstetric patients who received an accidental dural puncture is described. Headache attributable to dural puncture occurred in 85% of patients managed conservatively. Epidural infusion or repeat epidural bolus injections of saline after delivery reduced the incidence to 65%. A therapeutic autologous blood patch using 8-10 ml of blood was performed in 28 patients at least 24 hours after the accidental puncture. Dramatic and permanent relief occurred in 75% following this procedure. A repeat blood patch was effective in four patients, and ineffective in the remaining two. Mild and temporary back stiffness and one case of moderately severe radicular pain for three days were the only complications noted after the procedure. The pathophysiology and treatment of dural puncture headache is reviewed. Reduction of pressure differential across the dural puncture site is most useful in the first 24-48 hours. Persistent and severe headache occurring after this should be treated with blood patch.

scholarly journals Targeted Transforaminal Epidural Blood Patch for Postdural Puncture Headache in Patients with Postlaminectomy Syndrome

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Yu Na Choi ◽  
Sang Ji Kang ◽  
Jin Deok Joo ◽  
Yu Mi Kim ◽  
Jang Hyeok In ◽  
...  
Keyword(s):  
Gold Standard ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Therapeutic Option ◽  
Severe Headache ◽  
Low Back ◽  
Postdural Puncture Headache ◽  
Lower Back ◽  
Interlaminar Approach ◽  
Blood Patch

Postdural puncture headache is a leak of cerebrospinal fluid that lowers intracranial pressure and usually presents as a positional headache. If conservative treatments are not successful, the epidural blood patch is the gold standard of the treatment for dural puncture. The interlaminar approach is the most commonly used technique for an epidural blood patch. This case report describes a patient who was treated with a transforaminal epidural blood patch for postdural puncture headache following an acupuncture procedure on his lower back after two epidural blood patches using an interlaminar approach had failed. The patient underwent an acupuncture therapy for management of chronic low back pain due to postlaminectomy syndrome. After the procedure, the patient had a severe headache and the conservative treatment was not effective. The two interlaminar epidural blood patches at the L2–3 level and at the L3–4 level were failed. We performed transforaminal epidural blood patch at the L3–4 and L4–5 levels on the left side, the site of leakage in the MRI myelogram. His symptoms finally subsided without complication. This case demonstrates that targeted transforaminal epidural blood patch is a therapeutic option for the treatment of postdural puncture headache when epidural blood patch using an interlaminar approach is ineffective.

scholarly journals Blood patch for the treatment of post-dural puncture tinnitus

2018 ◽  
Vol 6 ◽  
pp. 2050313X1875944
Author(s):  
Wei Jia ◽  
Fiqry Fadhlillah
Keyword(s):  
Hearing Loss ◽  
Lumbar Puncture ◽  
Complete Resolution ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Venous Blood ◽  
Medical Problem ◽  
Tinnitus Handicap Inventory ◽  
Post Procedure ◽  
Blood Patch

Audiometric disturbances are recognised as potential complications after spinal or epidural anaesthesia; however, incidences of tinnitus occur less frequently. We report a case of a patient with severe bilateral tinnitus post-lumbar puncture who was treated with an epidural blood patch. A 40-year-old ASA I lady (a medically fit patient with no known medical problem) presented with ongoing bilateral severe tinnitus for 6 days after a lumbar puncture. Venous blood (18 mL) was injected into the epidural space using a 16G needle. The patient completed the Tinnitus Handicap Inventory Questionnaire before the blood patch, 3 h, 24 h and 1-month post-procedure. An audiogram was also conducted before and 1 month after the blood patch. The patient scored 84 (grade 5) on the Tinnitus Handicap Inventory before the blood patch. Three hours post-procedure, her score improved to 16 (grade 1), with complete resolution by 24 h. Audiogram revealed a low-frequency mild sensorineural hearing loss in the left ear prior to the procedure. By her 1-month follow-up, her hearing loss was back to normal. In our experience, an epidural blood patch is an effective treatment for post-dural puncture tinnitus. Its effects are instantaneous and complete resolution is achieved by 24 h.

scholarly journals Pneumocephalus following labour epidural analgesia, a rare case report

2021 ◽  
Vol 4 (2) ◽  
pp. 066-068
Author(s):  
Rafiq Shagufta ◽  
Abbasher Ibrahim ◽  
Denona Branko ◽  
Anwar Sadia ◽  
Ahmad Ammara ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Rare Case ◽  
Dural Puncture ◽  
Severe Headache ◽  
Oxygen Inhalation ◽  
Lumbar Epidural Analgesia ◽  
Loss Of Resistance ◽  
Labour Epidural Analgesia ◽  
Rare Case Report ◽  
The Brain

The lumbar epidural analgesia is commonly used for labour analgesia. The “loss of resistance to air” LORA technique is commonly used for recognition of epidural space. One of the rare complications of this technique is Pneumocephalus (PC). We want to present a case of Pneumocephalus which the mother developed during epidural analgesia in labour. The patient complained of severe headache immediately after attempt at epidural catheter insertion. The symptoms progressively worsened following delivery. A postnatal anaesthetic review was performed and an urgent CT scan of the brain was arranged that showed pneumocephalus. A conservative management pathway was followed with liberal analgesia, oxygen inhalation and keeping the patient mostly in supine position. Her symptoms regressed in severity over the next three days and subsided after one week. We believe that the amount of air used for LORA should be minimized; LORA should not be used after dural puncture and the use of normal saline would alleviate the risk.

scholarly journals Comparisons of clinical characteristics, brain MRI findings, and responses to epidural blood patch between spontaneous intracranial hypotension and post-dural puncture headache: retrospective study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gha-Hyun Lee ◽  
Jiyoung Kim ◽  
Hyun-Woo Kim ◽  
Jae Wook Cho
Keyword(s):  
Intracranial Hypotension ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Brain Mri ◽  
Spontaneous Intracranial Hypotension ◽  
Vein Of Galen ◽  
Mri Findings ◽  
Post Dural Puncture Headache ◽  
Straight Sinus ◽  
Blood Patch

Abstract Background Spontaneous intracranial hypotension and post-dural puncture headache are both caused by a loss of cerebrospinal fluid but present with different pathogeneses. We compared these two conditions concerning their clinical characteristics, brain imaging findings, and responses to epidural blood patch treatment. Methods We retrospectively reviewed the records of patients with intracranial hypotension admitted to the Neurology ward of the Pusan National University Hospital between January 1, 2011, and December 31, 2019, and collected information regarding age, sex, disease duration, hospital course, headache intensity, time to the appearance of a headache after sitting, associated phenomena (nausea, vomiting, auditory symptoms, dizziness), number of epidural blood patch treatments, and prognosis. The brain MRI signs of intracranial hypotension were recorded, including three qualitative signs (diffuse pachymeningeal enhancement, venous distention of the lateral sinus, subdural fluid collection), and six quantitative signs (pituitary height, suprasellar cistern, prepontine cistern, mamillopontine distance, the midbrain-pons angle, and the angle between the vein of Galen and the straight sinus). Results A total of 105 patients (61 spontaneous intracranial hypotension patients and 44 post-dural puncture headache patients) who met the inclusion criteria were reviewed. More patients with spontaneous intracranial hypotension required epidural blood patch treatment than those with post-dural puncture headache (70.5% (43/61) vs. 45.5% (20/44); p = 0.01) and the spontaneous intracranial hypotension group included a higher proportion of patients who underwent epidural blood patch treatment more than once (37.7% (23/61) vs. 13.6% (6/44); p = 0.007). Brain MRI showed signs of intracranial hypotension in both groups, although the angle between the vein of Galen and the straight sinus was greater in the post-dural puncture headache group (median [95% Confidence Interval]: 85° [68°-79°] vs. 74° [76°-96°], p = 0.02). Conclusions Patients with spontaneous intracranial hypotension received more epidural blood patch treatments and more often needed multiple epidural blood patch treatments. Although both groups showed similar brain MRI findings, the angle between the vein of Galen and the straight sinus differed significantly between the groups.

Incidence of postural headache after lumbar puncture requiring epidural blood patch: Effects of needle caliber; 2-year experience

2021 ◽  
pp. 197140092110006
Author(s):  
Warren Chang ◽  
Ajla Kadribegic ◽  
Kate Denham ◽  
Matthew Kulzer ◽  
Tyson Tragon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Puncture ◽  
Conservative Management ◽  
Epidural Blood Patch ◽  
Female Gender ◽  
Regional Hospital ◽  
Younger Age ◽  
Blood Patch ◽  
History Of ◽  
The Difference

Purpose A common complication of lumbar puncture (LP) is postural headaches. Epidural blood patches are recommended if patients fail conservative management. Owing to a perceived increase in the number of post-lumbar puncture headaches (PLPHs) requiring epidural blood patches at a regional hospital in our network, the decision was made to switch from 20 to 22 gauge needles for routine diagnostic LPs. Materials and methods Patients presenting for LP and myelography at one network regional hospital were included in the study. The patients were contacted by nursing staff 3 days post-procedure; those patients who still had postural headaches after conservative management and received epidural blood patches were considered positive cases. In total, 292 patients were included; 134 underwent LP with 20-gauge needles (53 male, 81 female, average age 57.7) and 158 underwent LP with 22-gauge needles (79 male, 79 female, average age 54.6). Results Of 134 patients undergoing LP with 20-gauge needles, 15 (11%) had PLPH requiring epidural blood patch (11 female, 3 male, average age 38). Of 158 patients undergoing LP with 22-gauge needles, only 5 (3%) required epidural blood patches (all female, average age 43). The difference was statistically significant ( p < 0.01). Risk factors for PLPH included female gender, younger age, lower body mass index, history of prior PLPH and history of headaches. Conclusion Switching from 20-gauge to 22-gauge needles significantly decreased the incidence of PLPH requiring epidural blood patch. Narrower gauge or non-cutting needles should be considered in patients with risk factors for PLPH, allowing for CSF requirements.

Rational-Emotive Therapy and Depression: A Clinical Case Study

1980 ◽  
Vol 51 (3) ◽  
pp. 853-854
Author(s):  
Arthur Mac Neill Horton ◽  
Carl H. Johnson
Keyword(s):  
Depressed Patient ◽  
Test Data ◽  
Clinical Setting ◽  
Clinical Case ◽  
Clinical Settings ◽  
Dramatic Improvement ◽  
Rational Emotive Therapy ◽  
Clinical Case Study ◽  
Rational Emotive

Rational-emotive group and bibliotherapy were used to treat a depressed patient in a clinical setting. Psychological test data document a dramatic improvement. It is suggested that rational-emotive therapy may prove efficacious for the treatment of some depressed patients in clinical settings.

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