scholarly journals Transforaminal Epidural Blood Patch

2007 ◽  
Vol 4;10 (7;4) ◽  
pp. 579-582
Author(s):  
Lawrence Weil
Keyword(s):  
Conservative Management ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Epidural Injection ◽  
Low Back ◽  
Epidural Injections ◽  
Transforaminal Approach ◽  
Blood Patch ◽  
Key Words Blood

Spinal headache is an occasional, but painful complication of epidural injection procedures due to dural puncture that allows leakage of CSF from the thecal sac, thereby reducing intracranial pressure. In the event of failure of conservative management, (e.g. abdominal binder, fluids, acetaminophen), an epidural blood patch is often used. This case report describes a patient with spinal headache after a transforaminal selective epidural injection in a post laminectomy patient that was treated with a transforaminal epidural blood patch after the failure of conservative management. The patient underwent left transforaminal epidural injections at L5 and S1 for management of chronic low back pain secondary to post laminectomy syndrome. Three days later, the patient presented with a severe post lumbar puncture headache and failed to respond to conservative management. Interlaminar epidural approach for blood patch was not feasible secondary to prior laminectomy. Transforaminal epidural blood patch was performed utilizing 2 mL of autologous blood at each of the two sites. The patient recovered well without headache. In cases, with inability to perform interlaminar blood patch, a transforaminal approach may be considered. Key words: blood patch, epidural, spinal headache, transforaminal

Post–Dural Puncture Headache

2017 ◽  
Author(s):  
Philip Rubin
Keyword(s):  
Cerebrospinal Fluid ◽  
Epidural Space ◽  
Gold Standard ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Caffeine Intake ◽  
Recumbent Position ◽  
Post Dural Puncture Headache ◽  
Blood Patch

Post–dural puncture headache (PDPH) is a benign but debilitating condition that may occur as a consequence of any dural puncture, whether intentional (as with spinal anesthesia or lumbar puncture) or inadvertent (as with epidural anesthesia). The headache is characteristically unique, as it is postural in nature—worsened when sitting or standing, and markedly improved in the recumbent position. After the puncture, passage of cerebrospinal fluid (CSF) across the dura mater from a pressurized environment (subarachnoid space) to the epidural space, is the initial culprit behind the headache. Noninvasive conservative measures including hydration, analgesics, and caffeine intake are typically offered as initial treatments, but if those measures fail, the “gold standard” epidural blood patch is commonly offered. This procedure entails injection of autologous blood into the epidural space to both halt continued CSF “loss,” and to increase CSF pressure, both of which aid in headache resolution.

Spontaneous Intracranial Hypotension

2018 ◽  
Author(s):  
Magdalena Anitescu ◽  
David Arnolds
Keyword(s):  
Intracranial Hypotension ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Spontaneous Intracranial Hypotension ◽  
Delay In Diagnosis ◽  
Blood Patch ◽  
Cord Injury ◽  
Detailed Medical History ◽  
Proper Diagnosis

Spontaneous intracranial hypotension is a condition that affects young and middle-aged individuals. Women are more frequently affected than men. It is associated with severe positional headache without previous dural puncture and is often confused with other common headache conditions. Delay in diagnosis of the condition may predispose patients to severe complications. Many radiodiagnostic tools carry important risks to patients, including nerve injury and iatrogenic spinal cord injury. Imaging studies must be correlated with a detailed medical history and a thorough physical examination. Epidural blood patch, the mainstay of treatment, may require multiple attempts with increasing amounts of autologous blood. Increased awareness of spontaneous intracranial hypotension will likely contribute to its proper diagnosis and treatment.

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 Allogeneic Epidural Blood Patch in the Setting of Persistent Spinal Headache and Disseminated Coccidioidomycosis

2009 ◽  
Vol 3;12 (3;5) ◽  
pp. 639-643 ◽  
Author(s):  
Terrence L. Trentman
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Blood Donation ◽  
Autologous Blood ◽  
Post Dural Puncture Headache ◽  
Increased Risk ◽  
Blood Patch ◽  
The Central Nervous System

In most cases of post-dural puncture headache, the positional symptoms will resolve spontaneously within 2 weeks. Conservative therapies include oral analgesics and hydration, bed rest, and abdominal binders. For refractory cases, an autologous epidural blood patch remains the treatment of choice. However, in certain cases the use of autologous blood for the blood patch may place the patient at risk for infectious or malignant contamination of the central nervous system. Coccidioidomycosis results from inhalation of the arthroconidia (spore) stage of the fungal lifecycle. The most common manifestation of coccidioidomycosis is acute pulmonary symptoms, while the most feared complication is meningitis. Immunocompromised patients are at increased risk of fungemia; therefore, introduction of fungal elements into the central nervous system can occur if autologous blood is used for an epidural blood patch. We report a case of persistent dural-puncture headache in the setting of disseminated coccidioidomycosis. An autologous blood epidural blood patch was considered but deferred due to risk of coccidioidomycosis meningitis. Other epidural space interventions such as fibrin glue injection or saline infusions were judged to be too imprecise or ineffective. The patient was successfully treated with allogeneic blood donated by his wife, but only after testing of her blood as is required for any directed blood donation. Allogeneic epidural blood patches are an option for refractory dural puncture headaches when autologous blood may cause meningitis or malignant seeding of the central nervous system. Key words: Epidural blood patch, post-dural puncture headache, Coccidioidomycosis, arthroconidia, acute pulminary symptoms

Efficacy of a Prophylactic Epidural Blood Patch in Preventing Post Dural Puncture Headache in Parturients after Inadvertent Dural Puncture

2004 ◽  
Vol 101 (6) ◽  
pp. 1422-1427 ◽  
Author(s):  
Barbara M. Scavone ◽  
Cynthia A. Wong ◽  
John T. Sullivan ◽  
Edward Yaghmour ◽  
Saadia S. Sherwani ◽  
...  
Keyword(s):  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Onset Time ◽  
Double Blind Study ◽  
Double Blind ◽  
Epidural Catheter Placement ◽  
Blood Patch ◽  
To Receive ◽  
Patch Group

Background Postdural puncture headache (PDPH) occurs in up to 80% of parturients who experience inadvertent dural puncture during epidural catheter placement. The authors performed a randomized double blind study to assess the effect of prophylactic epidural blood patch on the incidence of PDPH and the need for therapeutic epidural blood patch. Methods Sixty-four parturients who incurred inadvertent dural puncture were randomized to receive a prophylactic epidural blood patch with 20 ml autologous blood (prophylactic epidural blood patch group) or a sham patch (sham group). Subjects were evaluated daily for development of PDPH for a minimum of 5 days after dural puncture. Those who developed a PDPH were followed daily for a minimum of 3 days after resolution of the headache. Subjects with moderate headaches who reported difficulties performing childcare activities and all those with severe headaches were advised to receive a therapeutic epidural blood patch. Results Eighteen of 32 subjects in each group (56%) developed PDPH. Therapeutic blood patch was recommended in similar numbers of patients in each group. The groups had similar onset time of PDPH, median peak pain scores, and number of days spent unable to perform childcare activities as a result of postural headache. The median duration of PDPH, however, was shorter in the prophylactic epidural blood patch group. Conclusions A decrease in the incidence of PDPH or the need for criteria-directed therapeutic epidural patch was not detected when a prophylactic epidural blood patch was administered to parturients after inadvertent dural puncture. However, prophylactic epidural blood patch did shorten the duration of PDPH symptoms.

scholarly journals Epidural blood patch in post-dural puncture headache in parturients: A case series

2020 ◽  
Vol 9 (3) ◽  
pp. 169-172
Author(s):  
Babu Raja Shrestha ◽  
Shyam Krishna Maharjan ◽  
Ujma Shrestha ◽  
Sushila Lama Moktan
Keyword(s):  
Pharmacological Treatment ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Case Series ◽  
Post Dural Puncture Headache ◽  
Blood Patch ◽  
Typical History ◽  
History Of ◽  
Persistent Headache

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.

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

2014 ◽  
Vol 5 (3) ◽  
pp. 170-172 ◽  
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.

scholarly journals Considerations for Epidural Blood Patch and Other Postdural Puncture Headache Treatments in Patients with COVID-19

2020 ◽  
Vol 4S;23 (8;4S) ◽  
pp. S305-S310
Author(s):  
Pascal Scemama
Keyword(s):  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Primary Concern ◽  
Pharmacological Treatments ◽  
Nerve Blocks ◽  
Post Dural Puncture Headache ◽  
Current State ◽  
Important Concern ◽  
Blood Patch

Background: A primary concern in the use of EBP in these patients is the possibility of seeding the virus in the CNS. Another important concern is related to the known hypercoagulable state in COVID-19 positive patients and associated organ dysfunction that may alter the metabolism of anticoagulants. The safety of the providers performing the EBP, the position of the patient and choices for image guidance (blind, fluoroscopic) are also key considerations to review. It is also important to explore the current state of knowledge about using allogenic instead of autologous blood as well as emerging techniques to eliminate the coronavirus from the blood. Objectives: In this article we pose the questions of how to manage PDPH in the COVID-19 positive patient and more specifically, the use of epidural blood patch (EBP). Methods: Literature review. Results: EBP is usually considered after the failure of conservative and pharmacological treatments. Because of the additional risks of EBP in COVID-19 patients it is important to also consider less traditional pharmacological treatments such as theophylinnes and cosyntropin that may offer some additional benefit for COVID-19 patient. Finally, other interventions other than EBP should also be considered including occipital nerve blocks, sphenopalatine ganglion blocks (infratemporal or transnasal). Limitations: A narrative review with paucity of literature. Conclusion: Going forward, an effective treatment for COVID-19 or a safe vaccine and a deeper understanding of the pathophysiology of the virus will certainly change the risk calculus involved in performing an EBP in a COVID-19 patient. Key words: COVID-19; PDPH; Epidural Blood Patch; Post-dural Puncture Headache

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.

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