Epidural blood patch for an eight-months’ history of post-dural puncture headache: case report

This is a case series of six obstetric patients who had post-dural puncture headache, resistant to conservative treatment. The onset of post-dural headache in our series on average was on the 34th hour of the procedure. After confirmation of the diagnosis with a typical history of presentation and examination, the patients underwent pharmacological treatment. Post-dural puncture headache, in our series, not relieved by pharmacological treatment underwent epidural blood patch after persistent headache in an average of 5 days post-dural puncture. All patients receiving this therapy had a complete cure of headache at the earliest - from 45 minutes to as late as 11 hours post procedure. Epidural autologous blood instillation in an average of 10 to 11 ml completely relieved the ailment in the primary blood patch. Epidural blood patch is still considered gold standard therapy in persistent post-dural puncture headache.

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Treatment of post-dural puncture headache using epidural injection of fibrin sealant as an alternative to autologous epidural blood patch (case report)

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2014.04.002 ◽

2014 ◽

Vol 5 (3) ◽

pp. 170-172 ◽

Cited By ~ 2

Author(s):

Joseph Atallah ◽

Emmanuel Gage ◽

Jonathan Koning ◽

Joan Duggan ◽

Vicki Ramsey-Williams ◽

...

Keyword(s):

Case Report ◽

Fibrin Sealant ◽

Dural Puncture ◽

Epidural Blood Patch ◽

Epidural Injection ◽

Post Dural Puncture Headache ◽

Patient Morbidity ◽

Blood Patch ◽

Immunodeficiency Virus ◽

Diagnostic Lumbar Puncture

AbstractBackgroundPost dural puncture headache (PDPH) is an iatrogenic cause of patient morbidity in pain management after spinal or epidural anaesthesia, as well as after diagnostic lumbar puncture. Most patients respond to conservative treatment or to epidural blood patch, yet limited options for effective treatment are available for patients who fail these treatments or present with theoretical contraindication.Case reportWe present a case of a patient with previously diagnosed human immunodeficiency virus and hepatitis C, who presented with signs of PDPH, which placed him at a theoretical risk of meningeal seeding of the virus during the blood patching procedure.ConclusionWe successfully treated the post dural puncture headache and avoided the risk of viral seeding of the meninges by using a fibrin sealant.

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Epidural Blood Patch for Chronic Daily Headache with Postural Component: A Case Report and the Review of Published Cases

January 2018 - Pain Physician ◽

10.36076/ppj.2008/11/77 ◽

2008 ◽

Vol 1;11 (1;1) ◽

pp. 77-80

Author(s):

Shihab Ahmed

Keyword(s):

Chronic Daily Headache ◽

Dural Puncture ◽

Epidural Blood Patch ◽

Acute Onset ◽

Postural Headache ◽

Post Dural Puncture Headache ◽

Blood Patch ◽

History Of ◽

Daily Headache ◽

One Year

Post dural puncture headache (PDPH) can be observed after any trauma to the dura. The hallmark of PDPH is an increasing headache when assuming the upright position and improvement with the supine position. Diagnosis of PDPH is essentially based on history of dural puncture and clinical presentation. In most cases, if initial conservative therapies fail to provide the relief of symptoms, an epidural blood patch is the therapy of choice. Epidural blood patch is a safe and effective treatment for PDPH and routinely done for acute onset of postural headache after spinal or epidural anesthesia or analgesia. Here, we report the successful treatment of chronic daily headache with a postural component via an epidural blood patch one year after the onset. We also review the literature pertinent to the use of epidural blood patch in chronic daily headache patients with postural component. Key words: Post-dural puncture headache, postural headache, chronic daily headache, epidural blood patch

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Challenges and Successful Management of Chronic Post Dural Puncture Headache Using Epidural Blood Patch in Low-Income Setting: Case Report

Biomedical Journal of Scientific & Technical Research ◽

10.26717/bjstr.2020.32.005195 ◽

2020 ◽

Vol 32 (1) ◽

Author(s):

George Uchenna Eleje

Keyword(s):

Case Report ◽

Low Income ◽

Dural Puncture ◽

Epidural Blood Patch ◽

Successful Management ◽

Post Dural Puncture Headache ◽

Blood Patch ◽

Low Income Setting

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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 ◽

10.1186/s12883-021-02279-5 ◽

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.

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