scholarly journals Delayed Radicular Pain Following Two Large Volume Epidural Blood Patches for Post-Lumbar Puncture Headache: A Case Report

2010 ◽  
Vol 3;13 (3;5) ◽  
pp. 257-262
Author(s):  
Mehul J. Desai
Keyword(s):  
Case Report ◽  
Lumbar Puncture ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Radicular Pain ◽  
Safe Procedure ◽  
Postdural Puncture Headache ◽  
Postural Headache ◽  
Blood Patch ◽  
Diagnostic Lumbar Puncture

Introduction: Postdural puncture headache (PDPH) is a known complication of diagnostic lumbar puncture. Multiple factors including needle size, type, and needle bevel orientation, have been postulated to contribute to the development of PDPH. The presentation of PDPH tends to have classic symptoms that include a postural headache, nausea, vomiting, tinnitus, and ocular disturbances. Conservative treatment measures include bed rest, intravenous hydration or caffeine, and analgesics. Resistant cases might require an epidural blood patch (EBP). Though complications are rare, cases of immediate post-procedural pain and subdural epidural hematoma have been reported. Here we present a case of PDPH treated with sequential EBPs that resulted in delayed radicular pain. Case Report: A 29-year-old female presented to the emergency room with a severe frontal headache of several days duration. She underwent a diagnostic lumbar puncture as a part of her work-up. Then, 24-48 hours later she developed a severe postural headache unresponsive to conservative care. Two days later she underwent an epidural blood patch with 20 mL of autologous blood. Her symptoms did not abate, prompting a repeat EBP within 24 hours with an additional 20 mL of autologous blood. Five days later the patient began experiencing muscle spasms and radicular pain in the buttocks and left posterior leg that radiated to her posterior calf. The patient was initially started on pregabalin 25mg 3 times daily, and underwent a gadonlinum-enhanced MRI of the lumbar spine. She followed up 5 days later with unchanged symptoms and a negative MRI. She was then started on a methylprednisolone taper and continued the pregabalin. At the 10-day follow-up, there was 90% resolution of symptoms and a pain intensity of 1/10 on NRS. At this time she is continuing the pregabalin with plans to discontinue medication. Discussion: Although EBP is typically a safe procedure, complications might occur. An inflammatory response, secondary to the injection of blood, or mechanical compression, due to the total volume of blood injection, are highlighted as possible causative agents in the development of this complication. The role of fluoroscopic imaging, particularly in patients who have failed an initial EBP, must also be examined. Given the rates of false loss of resistance (17- 30%) reported in the literature, the use of real-time imaging to ensure proper needle placement and subsequent injectate spread should be considered. Key words: Blood patch, epidural, radiculopathy, postdural puncture headache, complications, fluoroscopy, epidural

scholarly journals It Is Just a Blood Patch: Considerations for Patients with Preexisting Intracranial Hypertension

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Devina Shiwlochan ◽  
Sargis Ohanyan ◽  
Kanishka Rajput
Keyword(s):  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Autologous Blood ◽  
Benign Intracranial Hypertension ◽  
Postdural Puncture Headache ◽  
Opening Pressure ◽  
Blood Patch ◽  
Diagnostic Lumbar Puncture ◽  
Routine Procedures ◽  
Definitive Management

Epidural blood patches are routine procedures interventional pain physicians perform for postdural puncture headaches (PDPH), whether it be due to the inadvertent wet tap from an epidural or a diagnostic lumbar puncture. Typically, these patients are relatively healthy and an epidural is relatively straightforward. However, there are cases complicated by a neurologic history such as benign intracranial hypertension. Here, we present a case of a patient with benign intracranial hypertension (BIH) that suffered a postdural puncture headache after a diagnostic lumbar puncture, with no documented opening pressure, continued on acetazolamide. There have only been a small number of documented cases of BIH complicated by PDPH. We discuss the medical management of BIH, how it can exacerbate a postdural puncture headache, our definitive management with an epidural blood patch, and our concerns of rebound intracranial hypertension. We demonstrate that treatment of PDPH in BIH is best managed with image-guided blood patches, with smaller volume of autologous blood, and at a slower rate.

Successful transforaminal epidural blood patch in a patient with multilevel spinal fusion

2020 ◽  
Vol 45 (9) ◽  
pp. 746-749
Author(s):  
Hanwool Ryan Choi ◽  
Benjamin Fuller ◽  
Michael Magdy Bottros
Keyword(s):  
Case Report ◽  
Spinal Fusion ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Anatomical Variations ◽  
Needle Insertion ◽  
Electrode Placement ◽  
Epidural Needle ◽  
First Case ◽  
Blood Patch

IntroductionEpidural blood patch (EBP) is a vital tool in treating postdural puncture headache (PDPH). Traditional interlaminar epidural needle insertion into the epidural space, however, may be challenging due to anatomical variations. As an alternative method, we successfully performed an EBP via transforaminal approach.Case reportA mid-50-year-old male patient with multilevel spinal fusion developed PDPH after a failed spinal cord stimulator electrode placement. A transforaminal EBP was carried out by injecting a total of 8 mL of autologous blood into the neuroforamen at the L1–L2 level bilaterally. Our patient’s positional headache resolved immediately after the procedure.DiscussionTo our knowledge, this is the first case reported of a transforaminal EBP in a patient with diffuse epidural adhesive fibrosis secondary to multilevel laminectomies and spinal fusion. This case report highlights potential risks and benefits of this novel technique and also discusses its therapeutic mechanism of action. We believe that a transforaminal EBP should be considered in patients who are poor candidates for the traditional interlaminar EBP.

scholarly journals Pneumocephalus after an autologous blood patch procedure to treat a postdural puncture headache - A case report -

2008 ◽  
Vol 55 (3) ◽  
pp. 387 ◽  
Author(s):  
Seung Soo Lee ◽  
Sang Gon Lee ◽  
Byung Woo Min ◽  
Jong Suk Ban ◽  
Ji Hyang Lee ◽  
...  
Keyword(s):  
Case Report ◽  
Autologous Blood ◽  
Postdural Puncture Headache ◽  
Blood Patch

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.

Postdural puncture headache

2016 ◽  
Author(s):  
Michael J. Paech ◽  
Patchareya Nivatpumin
Keyword(s):  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Bed Rest ◽  
Symptomatic Treatment ◽  
Epidural Needle ◽  
Fluid Loss ◽  
Postdural Puncture Headache ◽  
Intrathecal Catheter ◽  
Blood Patch ◽  
Obstetric Population

Postdural puncture headache (PDPH) may follow either deliberate or unintentional (accidental) penetration of the interdigitating meninges, the dura and arachnoid mater. It is one of the most common and clinically important complications of regional anaesthesia and analgesia in the obstetric population. The headache develops as a consequence of cerebrospinal fluid loss, low intracranial pressure and cerebrovascular changes in the upright position and can prove debilitating. The diagnosis is clinical, making thorough assessment and regular review all the more important, to revise treatment plans, exclude rare serious pathology such as subdural haematoma, and avoid misdiagnosis. This chapter reviews the pathophysiology, incidence, risk factors (needle, technical and patient related), features, natural history, diagnosis, and management of PDPH. High level evidence supports prevention by using small gauge, non-cutting spinal needles, but other preventative strategies against either unintentional dural puncture or PDPH are poorly supported. The absent or poor efficacy of measures such as bed rest, hydration, cerebral vasoconstrictor therapy, epidural or intrathecal saline injection, intrathecal catheter placement or prophylactic epidural blood patch, is noted. Validation of better evidence supporting epidural morphine or intravenous cosyntropin is required. Symptomatic treatment of PDPH is also unreliable. Very limited evidence that requires substantiation supports a modest benefit from caffeine, gabapentinoids or intravenous hydrocortisone. The intervention of epidural blood patch is highly likely to relieve post-spinal PDPH, but only completely resolves epidural needle-induced PDPH in 30–50% of cases. Much detail about EBP remains undetermined, but delayed intervention and injection of approximately 20 mL of autologous blood appear appropriate.

scholarly journals The effects of needle deformation during lumbar puncture

2015 ◽  
Vol 6 (02) ◽  
pp. 198-201 ◽  
Author(s):  
Hasan Hüseyin Özdemir ◽  
Caner F. Demir ◽  
Sefer Varol ◽  
Demet Arslan ◽  
Mustafa Yıldız ◽  
...  
Keyword(s):  
Waist Circumference ◽  
Lumbar Puncture ◽  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Blood Patch ◽  
Clinical Consequences ◽  
Diagnostic Lumbar Puncture ◽  
Measurement And Evaluation ◽  
Clinical Problems

ABSTRACT Objectives: The aim of this study is to assess deformation of the tip and deflection from the axis of 22-gauge Quincke needles when they are used for diagnostic lumbar puncture (LP). Thus, it can be determined whether constructional alterations of needles are important for predicting clinical problems after diagnostic LP. Materials and Methods: The 22-gauge Quincke needles used for diagnostic LP were evaluated. A specially designed protractor was used for measurement and evaluation. Waist circumference was measured in each patient. Patients were questioned about headaches occurring after LP. Results: A total of 115 Quincke-type spinal needles used in 113 patients were evaluated. No deflection was detected in 38 (33.1%) of the needles. Deflection between 0.1° and 5° occurred in 43 (37.3%) of the needles and deflection ≥ 5.1° occurred in 34 patients (29.6%). Forty-seven (41.5%) patients experienced post lumbar puncture headache (PLPH) and 13 (11.5%) patients experienced intracranial hypotension (IH). No statistically significant correlation between the degree of deflection and headache was found (P > 0.05). Epidural blood patch was performed for three patients. Deformity in the form of bending like a hook occurred in seven needles and IH occurred in six patients using these needles. Two of the needles used in three patients requiring blood patch were found to be bent. Conclusion: Deformation of needles may increase complications after LP. Needle deformation may lead to IH. In case of deterioration in the structure of the needle, termination of the puncture procedure and the use of a new needle could reduce undesirable clinical consequences, especially IH.

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.

Efficacy of epidural blood patch for postdural puncture headache

1993 ◽  
Vol 37 (7) ◽  
pp. 702-705 ◽  
Author(s):  
T. TAIVAINEN ◽  
M. PITKÄNEN ◽  
M. TUOMINEN ◽  
P. H. ROSENBERG
Keyword(s):  
Epidural Blood Patch ◽  
Postdural Puncture Headache ◽  
Blood Patch
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