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At least 433 records · Page 24Linked to original sources
PubMed2003

Post-dural puncture headache: pathophysiology, prevention and treatment.

Post-dural puncture headache (PDPHA) has been a vexing problem for patients undergoing dural puncture for spinal anaesthesia, as a complication of epidural anaesthesia, and after diagnostic lumbar puncture since Bier reported the first case in 1898. This Chapter discusses the pathophysiology of low-pressure headache resulting from leakage of cerebrospinal fluid (CSF) from the subarachnoid to the epidural spaces. Clinical and laboratory research over the last 30 years has shown that use of small-gauge needles, particularly of the pencil-point design, is associated with a lower risk of PDPHA than traditional cutting point needle tips (Quincke-point needles). A careful history can rule out other causes of headache. A positional component of headache is the sine qua non of PDPHA. In high-risk patients (e.g. age < 50 years, post-partum, large-gauge-needle puncture), patients should be offered early (within 24-48 h of dural puncture) epidural blood patch. The optimum volume of blood has been shown to be 12-20 ml for adult patients. Complications of autologous epidural blood patch are rare.

Anesthesia, Spinal↗
PubMed1991

[Aseptic meningitis following spinal anesthesia. Report of a case].

Aseptic meningitis after lumbar puncture and spinal anesthesia is a rare but serious complication, whose acute onset and clinical symptoms mimic septic meningitis. A 33 year old woman presented this complication 5 h after an uneventful cesarean section under subarachnoid blockade. Though lumbar puncture revealed pleocytosis with negative Gram stains and cultures, she was treated with antibiotics and made a full recovery. The clinical picture, differential diagnosis and value of early lumbar puncture are discussed. The successful use of midazolam to treat psychomotor agitation in this patient is also reported.

Adult↗
PubMed1990

Neurological deterioration in a patient with a spinal arteriovenous malformation following lumbar puncture. Case report.

The mechanism of nonhemorrhagic neurological deterioration from spinal arteriovenous malformation (AVM) and the role of acute surgical intervention in this setting are not well understood. The case is described of a 65-year-old man who presented with a 2-year history of mild gait spasticity and vague sensory complaints affecting both lower extremities. Following a diagnostic lumbar puncture, these symptoms progressed painlessly over a 4-day period to total motor paraplegia, urinary retention, and hypesthesia in all modalities with a midthoracic sensory level. Magnetic resonance imaging showed a probable spinal AVM but no evidence of hemorrhage or cord compression. Spinal angiography confirmed the diagnosis of spinal AVM fed by radicular branches of left T-7 and T-8 segmental intercostal arteries. Drainage was via long dorsal veins caudally. Emergency laminectomy with intradural exploration was performed. There was no evidence of prior hemorrhage or focal mass effect, although the cerebrospinal fluid pressure was elevated. The dural component of the spinal AVM was excised, and its communications with the spinal cord were disconnected intradurally. Neurological function started improving within 6 hours of the patient awakening from anesthesia. He had achieved antigravity strength in every muscle group of the lower extremities by the time of discharge to a rehabilitation center 10 days after surgery. Three months postoperatively, he was ambulating with a walker and was continent of urine and stool. Possible pathophysiological mechanisms are discussed in light of the favorable response to timely surgical intervention.

Aged↗
PubMed1996

[Chronic tinnitus and hearing loss caused by cerebrospinal fluid leak treated with success with peridural blood patch. Apropos of 2 cases].

Hearing loss and tinnitus are frequently encountered in ENT patients and usually require complementary investigations such as audiogram, auditive evoked potentials, CT scan, MRI... One recent etiology, that is more and more discovered, is a decrease in spinal fluid pressure secondary to a dural fluid leak that occurs after a diagnostic lumbar puncture, a spinal anesthesia, an accidental dural puncture during an epidural technique or a lumbar myelography. Postural headache which are frequently present in such a setting, may mask these auditive symptoms. Epidural injection of autologous blood (blood patch) performed by anesthesiologists, which is usually indicated to treat such postural headaches, is efficient in relieving other symptoms related to spinal fluid leak after dural puncture. We report two cases of isolated auditive complaints (hearing loss and tinnitus) which have been dramatically improved after blood patch. In conclusion, ENT surgeons should seek for a recent or even a past history of spinal puncture whenever the etiology of auditive symptoms of their patient remains unclear.

Adult↗
PubMed2003

Percutaneous intraspinal navigation: feasibility study of a new and minimally invasive approach to the spinal cord and brain in cadavers.

We describe a percutaneous approach for cerebral surgical access. After lumbar puncture, the spinal subarachnoid space was traversed by using standard angiographic guidewire techniques until the introducer catheters were in the intracranial space. Under fluoroscopic guidance, the intracranial subarachnoid space was navigated, and the ventricular system entered. Subarachnoid placement was confirmed with contrast-enhanced digital angiography. Placement anterior to the brain stem was confirmed in both cadavers during dissection, and spinal navigation without cord damage from the anterior or posterior approach was confirmed in one. Percutaneous intraspinal navigation is a new route of access for cerebrospinal surgery that has many potential applications.

Angiography↗