1
|
Uppal V, Russell R, Sondekoppam RV, Ansari J, Baber Z, Chen Y, DelPizzo K, Dirzu DS, Kalagara H, Kissoon NR, Kranz PG, Leffert L, Lim G, Lobo C, Lucas DN, Moka E, Rodriguez SE, Sehmbi H, Vallejo MC, Volk T, Narouze S. Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group. Reg Anesth Pain Med 2024; 49:471-501. [PMID: 37582578 DOI: 10.1136/rapm-2023-104817] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Postdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis or management of this condition is, however, currently lacking. This multisociety guidance aims to fill this void and provide practitioners with comprehensive information and patient-centric recommendations to prevent, diagnose and manage patients with PDPH. METHODS Based on input from committee members and stakeholders, the committee cochairs developed 10 review questions deemed important for the prevention, diagnosis and management of PDPH. A literature search for each question was performed in MEDLINE (Ovid) on 2 March 2022. The results from each search were imported into separate Covidence projects for deduplication and screening, followed by data extraction. Additional relevant clinical trials, systematic reviews and research studies published through March 2022 were also considered for the development of guidelines and shared with contributors. Each group submitted a structured narrative review along with recommendations graded according to the US Preventative Services Task Force grading of evidence. The interim draft was shared electronically, with each collaborator requested to vote anonymously on each recommendation using two rounds of a modified Delphi approach. RESULTS Based on contemporary evidence and consensus, the multidisciplinary panel generated 50 recommendations to provide guidance regarding risk factors, prevention, diagnosis and management of PDPH, along with their strength and certainty of evidence. After two rounds of voting, we achieved a high level of consensus for all statements and recommendations. Several recommendations had moderate-to-low certainty of evidence. CONCLUSIONS These clinical practice guidelines for PDPH provide a framework to improve identification, evaluation and delivery of evidence-based care by physicians performing neuraxial procedures to improve the quality of care and align with patients' interests. Uncertainty remains regarding best practice for the majority of management approaches for PDPH due to the paucity of evidence. Additionally, opportunities for future research are identified.
Collapse
Affiliation(s)
- Vishal Uppal
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robin Russell
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rakesh V Sondekoppam
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jessica Ansari
- Anesthesia Department, Stanford Health Care, Stanford, California, USA
| | - Zafeer Baber
- Department of Anesthesiology and Perioperative Medicine, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Yian Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA
| | - Kathryn DelPizzo
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Dan Sebastian Dirzu
- Anesthesia and Intensive Care, Emergency County Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Narayan R Kissoon
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter G Kranz
- Depatement of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lisa Leffert
- Department of Anesthesiology, Yale New Haven Health System; Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grace Lim
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics & Gynecology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Clara Lobo
- Anesthesiology Institute, Interventional Pain Medicine Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Dominique Nuala Lucas
- Department of Anaesthesia, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Eleni Moka
- Department of Anaesthesiology, Creta Interclinic Hospital - Hellenic Healthcare Group (HHG), Heraklion, Crete, Greece
| | - Stephen E Rodriguez
- Department of Anesthesia, Walter Reed Army Medical Center, Bethesda, Maryland, USA
| | - Herman Sehmbi
- Department of Anesthesia, Western University, London, Ontario, Canada
| | - Manuel C Vallejo
- Departments of Medical Education, Anesthesiology, Obstetrics & Gynecology, West Virginia University, Morgantown, West Virginia, USA
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Samer Narouze
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, OH, USA
| |
Collapse
|
2
|
Zhuang YD, Chen YZ, Lin QY, Chen YX, Zhong SQ, Lei D, Chen CM. Computerised modified paramedian approach technique versus conventional midline approach technique of lumbar puncture: a randomised control trial protocol. BMJ Open 2024; 14:e077941. [PMID: 38382963 PMCID: PMC10882310 DOI: 10.1136/bmjopen-2023-077941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/31/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION The lumbar puncture (LP) technique is widely used for diagnostic and therapeutic purposes. In recent years, the paramedian approach technique (PAT) has gained increasing interest due to its advantages over the conventional midline approach technique (MAT) that has been traditionally employed in clinical practice for LP. However, there have been inconsistent discussions regarding the efficacy of different LP techniques. Based on digital virtual human and computer simulation techniques, a new approach called computerised modified PAT (CMPAT) was proposed. Therefore, the aim of this study is to discuss a randomised controlled trial (RCT) protocol to investigate and compare the effects of CMPAT and MAT in patients undergoing LP. METHODS AND ANALYSIS We will conduct a prospective, multicentre RCT. The study will recruit 84 patients aged 18-99 years who require LP. Participants will be randomly assigned to either the CMPAT treatment group (group A) or the MAT treatment group (group B). The primary outcome measure will be the number of needle insertion attempts required for a successful LP. Secondary outcomes will include the puncture success rate, pain assessment in the back, head, and legs, and the occurrence of complications. The measurement of these secondary outcomes will be taken during the procedure, as well as at specific time points: 30 min, 6 hours, 1 day, 3 days, 7 days, 2 weeks and 4 weeks after the procedure. Pain levels will be assessed using a Numerical Rating Scale. ETHICS AND DISSEMINATION Ethical approval (2022YF052-01) has been obtained from the Ethics Committee of Fujian Medical University Union Hospital, Fuzhou, China. The research findings will be published in an international peer-reviewed scientific journal and presented at scientific conferences. TRIAL REGISTRATION NUMBER ChiCTR2300067937.
Collapse
Affiliation(s)
- Yuan-Dong Zhuang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yi-Ze Chen
- Fujian Medical University, Fuzhou, Fujian, China
| | - Qi-Ying Lin
- Fujian Medical University, Fuzhou, Fujian, China
| | - Yi-Xin Chen
- Fujian Medical University, Fuzhou, Fujian, China
| | - Si-Qi Zhong
- Fujian Medical University, Fuzhou, Fujian, China
| | - Ding Lei
- Fujian Medical University, Fuzhou, Fujian, China
| | - Chun-Mei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Department of Neurosurgery, Pingtan Comprehensive Experimentation Area Hospital, Pingtan, Fujian, China
| |
Collapse
|
3
|
Zetlaoui PJ, Buchheit T, Benhamou D. Epidural blood patch: A narrative review. Anaesth Crit Care Pain Med 2022; 41:101138. [DOI: 10.1016/j.accpm.2022.101138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 11/24/2022]
|
4
|
Korkut M, Bedel C. Abducens paralysis-a rare complication of spinal anesthesia at an emergency department: a case report. Acute Crit Care 2022; 39:acc.2021.01697. [PMID: 35791653 PMCID: PMC11392701 DOI: 10.4266/acc.2021.01697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022] Open
Abstract
The sixth cranial nerve (CN VI) is a rare site of complication associated with spinal anesthesia and can produce secondary symptoms of ocular muscle palsy. A 38-year-old man was admitted to the emergency department with complaint of diplopia and limited lateral gaze in the first week after endoscopic urological surgery under spinal anesthesia. Isolated unilateral CN VI palsy was considered after excluding differential diagnoses. Ocular palsy and diplopia regressed with conservative treatment during follow-up, and the patient was discharged. This article aims to show that CN VI palsy is a rare complication of spinal anesthesia, which can be observed in the emergency department.
Collapse
Affiliation(s)
- Mustafa Korkut
- Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Cihan Bedel
- Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| |
Collapse
|
5
|
Vilela MD, Pedrosa HA, Mesquita BF, Horiguchi CLF. Low-Pressure Hydrocephalus and Shunt Malfunction Following a Lumbar Puncture in an Adult Reversed by an Epidural Blood Patch. World Neurosurg 2020; 143:56-61. [PMID: 32712403 PMCID: PMC7377781 DOI: 10.1016/j.wneu.2020.07.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 11/06/2022]
Abstract
Background Low-pressure hydrocephalus (LPH) is a relatively rare condition, and its presentation is similar to the classically seen high-pressure hydrocephalus, with headaches, cranial nerve dysfunction, ataxia, and disturbances of consciousness. Cerebral cerebrospinal fluid loss in the presence of altered brain viscoelastic properties has previously been suggested as the pathophysiologic process leading to ventriculomegaly, despite low or negative intracranial pressures and patent shunts. More recently, cerebral venous overdrainage has been proposed as a possible explanation in the pathogenesis of LPH, although its connection to lumbar punctures in patients with shunts has not been contemplated yet. The effectiveness of epidural blood patch in the management of post-lumbar puncture LPH has been shown in children but has not been reported in adults. Case Description Herein we detail 2 episodes of shunt malfunction in a 30-year-old female patient with a history of hydrocephalus related to a posterior fossa tumor diagnosed during childhood. In both instances, imaging studies demonstrated ventricular dilation along with perimedullary cistern enlargement and brainstem distortion, which occurred following a lumbar puncture despite a patent shunt. A lumbar blood patch was effective in both episodes, enabling resolution of the ventriculomegaly and a good outcome. Conclusions A blood patch can be efficient in adults with post-lumbar puncture LPH. Some symptoms may be explained by brainstem compression caused by enlarged cerebrospinal fluid spaces at the skull base. The role of cerebral venous overdrainage in the setting of post-lumbar puncture LPH is further supported.
Collapse
Affiliation(s)
- Marcelo D Vilela
- Department of Neurological Surgery, University of Washington, Seattle, USA; Neurosurgery, Mater Dei Hospital, Belo Horizonte, Brazil.
| | | | | | | |
Collapse
|
6
|
Rineau E, Lécluse A, Pépin M, Lorin M, Dreux C, Loisel D, Gohier P. Late onset diplopia reversed by an epidural blood patch. Int J Obstet Anesth 2020; 42:115-117. [DOI: 10.1016/j.ijoa.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
|
7
|
Russell R, Laxton C, Lucas DN, Niewiarowski J, Scrutton M, Stocks G. Treatment of obstetric post-dural puncture headache. Part 2: epidural blood patch. Int J Obstet Anesth 2019; 38:104-118. [PMID: 30711239 DOI: 10.1016/j.ijoa.2018.12.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/12/2018] [Accepted: 12/16/2018] [Indexed: 12/31/2022]
Abstract
The 2009-12 MBRRACE-UK report highlighted the deaths of two women in whom dural puncture had occurred during insertion of a labour epidural catheter. Despite suffering long-term headaches, neither woman was adequately followed-up after discharge from hospital. Death resulted from a cerebral vein thrombosis in one case and a subdural haematoma in the other. Due to significant variation in the treatment of obstetric post-dural puncture headache, an Obstetric Anaesthetists' Association working group was set up to produce evidence-based guidelines to guide clinicians. These guidelines have been condensed into two review articles. In this second review, the role of an epidural blood patch is discussed using a question and answer format.
Collapse
Affiliation(s)
- R Russell
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - C Laxton
- Department of Anaesthetics, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - D N Lucas
- Department of Anaesthetics, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - J Niewiarowski
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Scrutton
- Department of Anaesthetics, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - G Stocks
- Department of Anaesthetics, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
8
|
Lee MS, Lee S, Seo DK, Yoon SH, Choi SS. Epidural blood patch treatment of diplopia that developed after headache resolution in a patient with spontaneous intracranial hypotension. J Dent Anesth Pain Med 2018; 18:255-259. [PMID: 30186972 PMCID: PMC6115369 DOI: 10.17245/jdapm.2018.18.4.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 11/15/2022] Open
Abstract
Sudden headache onset may rarely be caused by spontaneous intracranial hypotension (SIH). Other associated symptoms in patients with SIH are nausea, vomiting, vertigo, hearing alteration, and visual disturbance. This case report describes a 43-year-old female diagnosed with SIH who developed diplopia after resolution of an abrupt-onset headache, which was managed with conservative treatments, including bed rest and hydration. She was also diagnosed with secondary right sixth cranial nerve palsy. Although conservative management relieved her headache, the diplopia was not fully relieved. Application of an autologous epidural blood patch successfully relieved her diplopia, even after 14 days from the onset of visual impairment.
Collapse
Affiliation(s)
- Myung-Su Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sookyung Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Kyun Seo
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Syn-Hae Yoon
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
9
|
Zajac AE, Richardson MG. Postdural Puncture Headache Treated With Epidural Blood Patch and Subsequent Resolution of Atypical Odontalgia: A Case Report. A A Pract 2018; 11:73-75. [PMID: 29634557 DOI: 10.1213/xaa.0000000000000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 37-year-old gravida 5 para 4 with gestational hypertension underwent uneventful repeat cesarean delivery and tubal ligation under combined spinal-epidural anesthesia. On postoperative day 3, she developed a postural headache, unrelieved by caffeine, ibuprofen, and hydration. On postoperative day 8, she returned to the hospital for treatment. An epidural blood patch was administered, providing immediate and complete relief of her headache and bilateral upper and lower dental pain, which she noted arising concomitantly with her headache. We suspect bilateral traction on cranial nerve V2 and V3, secondary to intracranial hypotension after dural puncture, as the cause of her pain.
Collapse
Affiliation(s)
- Alexander E Zajac
- From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | |
Collapse
|
10
|
|
11
|
Li G, Zhu X, Zhang Y, Zhao J, Han Z, Hou K. Cranial nerve palsy secondary to cerebrospinal fluid diversion. Clin Neurol Neurosurg 2016; 143:19-26. [PMID: 26882270 DOI: 10.1016/j.clineuro.2016.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/01/2016] [Accepted: 02/07/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Cranial nerve palsy (CNP) secondary to cerebrospinal fluid (CSF) diversion is less familiar to us as a result of its rarity in incidence and insidiousness in presentation. This study aims to further expound the pathophysiological mechanism, clinical presentation, diagnosis, management and prognosis of CNP. METHODS From June 2012 to February 2015, 5 of 347 consecutive patients with CNPs secondary to different CSF diversion procedures were treated at our institution. A systematic PubMed search of published studies written in English for patients developing CNPs after CSF diversion procedures from January 1950 to June 2015 was conducted. RESULTS Overall, 29 studies and 5 patients of the current series totaling 53 CNPs met the inclusion criteria. CN II, III, IV, V, VI, VII and VIII were got involved in 2 (3.8%), 2 (3.8%), 5 (9.4%), 1 (1.9%), 44 (83.0%), 4 (7.5%) and 1 (1.9%) patients respectively. Thirty-eight patients (71.7%) developed CNPs following inadvertent lumbar puncture, 8 (15.1%) following lumbar drainage, and 7 (13.2%) following ventriculoperitoneal shunt. Forty-eight (90.6%) patients got resolved completely. CONCLUSIONS The proposed mechanism of CNP after CSF diversion procedure is CSF hypovolemia and subsequent downward displacement of the brain and traction and distortion of the vascular and peripheral neural structures. As a result of its distinct anatomic characteristics rather than long intracranial course, CN VI is most commonly affected. With early recognition and timely conservative management, most patients could get favorable recovery.
Collapse
Affiliation(s)
- Guichen Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaobo Zhu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yang Zhang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jinchuan Zhao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhiguo Han
- Department of Surgery, Changchun Orthopaedics Hospital, Changchun, Jilin, China
| | - Kun Hou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China.
| |
Collapse
|
12
|
Zinboonyahgoon N, Srinivasan S, Narang S. Harlequin Syndrome Following Implantation of Intrathecal Pumps: A Case Series. Neuromodulation 2015; 18:772-5. [DOI: 10.1111/ner.12343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 05/26/2015] [Accepted: 06/25/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Nantthasorn Zinboonyahgoon
- Department of Anesthesiology, Perioperative and Pain Medicine; Brigham and Women's Hospital; Boston MA USA
| | - Suresh Srinivasan
- Department of General Surgery; Creighton University Medical Center; Omaha NE USA
| | - Sanjeet Narang
- Department of Anesthesiology, Perioperative and Pain Medicine; Brigham and Women's Hospital; Boston MA USA
| |
Collapse
|
13
|
Abstract
In this article, we provide a literature review of cranial nerve (CN) VI injury after dural-arachnoid puncture. CN VI injury is rare and ranges in severity from diplopia to complete lateral rectus palsy with deviated gaze. The proposed mechanism of injury is cerebrospinal fluid leakage causing intracranial hypotension and downward displacement of the brainstem. This results in traction on CN VI leading to stretch and neural demyelination. Symptoms may present 1 day to 3 weeks after dural-arachnoid puncture and typically are associated with a postdural puncture (spinal) headache. Resolution of symptoms may take weeks to months. Use of small-gauge, noncutting spinal needles may decrease the risk of intracranial hypotension and subsequent CN VI injury. When ocular symptoms are present, early administration of an epidural blood patch may decrease morbidity or prevent progression of ocular symptoms.
Collapse
Affiliation(s)
- Jennifer E Hofer
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | | |
Collapse
|
14
|
Cain RB, Patel NP, Hoxworth JM, Lal D. Abducens palsy after lumbar drain placement. Laryngoscope 2013; 123:2633-8. [DOI: 10.1002/lary.24177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/11/2013] [Accepted: 04/03/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Rachel B. Cain
- Department of Otolaryngology; Mayo Clinic; Phoenix Arizona U.S.A
| | - Naresh P. Patel
- Department of Neurological Surgery; Mayo Clinic; Phoenix Arizona U.S.A
| | | | - Devyani Lal
- Department of Otolaryngology; Mayo Clinic; Phoenix Arizona U.S.A
| |
Collapse
|
15
|
Basaranoglu G, Saidoglu L. Isolated transient diplopia and nystagmus after spinal anesthesia. J Anesth 2013; 27:643-4. [PMID: 23455700 DOI: 10.1007/s00540-013-1575-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 02/03/2013] [Indexed: 11/25/2022]
|
16
|
Pulido Fontes L, Aymerich N, Martínez L. Paresia del VI par craneal tras anestesia epidural. Neurologia 2012; 27:442-3. [DOI: 10.1016/j.nrl.2011.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 12/17/2011] [Indexed: 10/28/2022] Open
|
17
|
VI cranial nerve palsy following epidural anaesthesia. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2012.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
18
|
Kim YA, Yoon DM, Yoon KB. Epidural Blood Patch for the Treatment of Abducens Nerve Palsy due to Spontaneous Intracranial Hypotension -A Case Report-. Korean J Pain 2012; 25:112-5. [PMID: 22514780 PMCID: PMC3324736 DOI: 10.3344/kjp.2012.25.2.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 01/16/2012] [Accepted: 01/16/2012] [Indexed: 01/18/2023] Open
Abstract
Intracranial hypotension is characterized by a postural headache which is relieved in a supine position and worsened in a sitting or standing position. Although less commonly reported than postural headache, sixth nerve palsy has also been observed in intracranial hypotension. The epidural blood patch (EBP) has been performed for postdural puncture headache, but little is known about the proper timing of EBP in the treatment of sixth nerve palsy due to intracranial hypotension. This article reports a case of sixth nerve palsy due to spontaneous intracranial hypotension which was treated by EBP 10 days after the onset of palsy.
Collapse
Affiliation(s)
- Yeon A Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul, Korea
| | | | | |
Collapse
|
19
|
Intravenous mannitol for treatment of abducens nerve paralysis after spinal anesthesia. Int J Obstet Anesth 2011; 20:271-2. [DOI: 10.1016/j.ijoa.2011.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 01/22/2011] [Accepted: 02/01/2011] [Indexed: 11/18/2022]
|
20
|
Paresia del VI par tras anestesia epidural. Neurologia 2011; 26:252-4. [DOI: 10.1016/j.nrl.2010.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 09/06/2010] [Accepted: 09/18/2010] [Indexed: 11/22/2022] Open
|
21
|
Cranial nerve III palsy resulting from intracranial hypotension caused by cerebrospinal fluid leak after paraspinal tumor resection: etiology and treatment options. Spine J 2011; 11:e10-3. [PMID: 21474076 DOI: 10.1016/j.spinee.2011.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 01/03/2011] [Accepted: 02/24/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intracranial hypotension typically occurs spontaneously. Acquired or secondary intracranial hypotension is less common but has been reported after spinal procedures, such as lumbar puncture. Cranial nerve (CN) III palsy is a rare sequela of intracranial hypotension. There are currently no established or standard interventions to treat intracranial hypotension. PURPOSE To describe a case of delayed CN III palsy resulting from intracranial hypotension because of a spinal cerebrospinal fluid (CSF) leak occurring during resection of a paraspinous tumor. STUDY DESIGN Case report. METHODS A 41-year-old woman underwent resection of a large thoracic schwannoma complicated by dural tear. Postoperatively, the patient was neurologically normal. She subsequently became acutely unresponsive and required reintubation. She awakened with intermittent headaches and was noted to have a right ptosis, which progressed to a complete right CN III palsy. RESULTS Initial head computed tomography showed evidence of a small, right-sided subdural hematoma. Magnetic resonance imaging (MRI) of the brain showed diffuse leptomeningeal enhancement and crowding of the foramen magnum consistent with intracranial hypotension. The patient's symptoms were treated successfully with flat bed rest. She fully recovered by time of discharge and at 6-month follow-up was neurologically normal. CONCLUSIONS Spinal surgery complicated by CSF leak is a potential cause of intracranial hypotension. Although most commonly associated with positional headaches, intracranial hypotension can cause uncommon symptoms, including acute mental status changes and CN deficits. Symptoms highly suspicious for intracranial hypotension accompanied by MRI of the brain are important for establishing a diagnosis of intracranial hypotension. Conservative treatment should be considered before attempting invasive intervention. As in the case presented, simple bed rest was a successful treatment option.
Collapse
|
22
|
Durán-Ferreras E. VI cranial nerve paralysis after epidural anaesthesia. NEUROLOGÍA (ENGLISH EDITION) 2011. [DOI: 10.1016/s2173-5808(11)70053-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
23
|
Corbonnois G, O'Neill T, Brabis-Henner A, Schmitt E, Hubert I, Bouaziz H. Unrecognized dural puncture during epidural analgesia in obstetrics later confirmed by brain imaging. ACTA ACUST UNITED AC 2010; 29:584-8. [PMID: 20619594 DOI: 10.1016/j.annfar.2010.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
Abstract
Accidental dural puncture is a well-recognized complication of obstetric epidurals that can potentially incapacitate the patient. Unrecognized dural puncture during epidural administration can lead to a delay in therapeutic intervention resulting in potentially serious complications. We report a case of a parturient who developed disabling intracranial hypotension and diplopia following accidental dural puncture during apparently uneventful epidural catheter insertion. Magnetic resonance neuroimaging was performed to confirm the diagnosis, and direct clinical management. We also discuss the role of neuroimaging in the investigation of postpartum headache.
Collapse
Affiliation(s)
- G Corbonnois
- Service d'anesthésie-réanimation chirurgicale, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France
| | | | | | | | | | | |
Collapse
|
24
|
Gibbins J, Steeds C, Greenslade GL, Tunstall SR, Patel NK, Stannard CF. To replace or not to replace? - Partial coning and a sixth nerve palsy secondary due to displacement of a tunnelled intrathecal catheter for pain control. Palliat Med 2008; 22:668-70. [PMID: 18612034 DOI: 10.1177/0269216308091558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report the displacement of a tunnelled intrathecal catheter causing significant cerebrospinal fluid (CSF) leak, resulting in partial coning and a sixth nerve palsy. The patient had advanced malignant mesothelioma and all other methods of pain control had been unsuccessful. As far as we are aware, there are no published reports of early replacement of an intrathecal catheter in patients with neurological sequelae. Surgical re-siting of the intrathecal catheter produced good pain relief for many months. Doctors involved in the use of indwelling intrathecal catheters for pain control must be aware of the risk of significant neurological sequelae but should not dismiss re-establishment of intrathecal therapy in the presence of significant neurological complications.
Collapse
Affiliation(s)
- J Gibbins
- The Macmillan Unit, North Bristol NHS Trust, Frenchay Hospital, Frenchay Park Road, Bristol, UK.
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW The treatment of postdural puncture headache remains controversial, largely because it is insufficiently evidence based. With high rates of neuraxial block in the obstetric population likely to continue, postdural puncture headache will remain a primary cause of morbidity and increased duration of hospital stay. This review describes new reports of relevance published in 2006 and until October 2007. RECENT FINDINGS New evidence justifies epidural blood patch as the treatment of choice for severe postdural puncture headache, but technical aspects such as optimal timing and volume are less clear. Symptomatic medical management remains diverse, with a multitude of therapies often advocated, despite a lack of scientific support. Reports of misdiagnosis and of complications associated with postdural puncture headache and its treatment emphasize the importance of multidisciplinary management and additional investigation, including radiological imaging, when the clinical picture warrants. SUMMARY The key reports in this epoch have shed light on the benefits of careful assessment of postpartum headache and treatment with an epidural blood patch. New management paradigms have been suggested and serious complications continue to be reported.
Collapse
|
26
|
Resolution of diplopia with late treatment of post-dural puncture headache and intracranial hypotension. Can J Anaesth 2008; 55:256-7. [DOI: 10.1007/bf03021517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
27
|
Sprigge JS, Harper SJ. Accidental dural puncture and post dural puncture headache in obstetric anaesthesia: presentation and management: a 23-year survey in a district general hospital. Anaesthesia 2007; 63:36-43. [PMID: 18086069 DOI: 10.1111/j.1365-2044.2007.05285.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Post dural puncture headache can be a debilitating complication of epidural and subarachnoid anaesthesia for a new mother. In a survey of 18,337 epidurals and 5021 subarachnoid blocks performed for obstetric procedures over a 23-year period in a district general hospital maternity unit, there were 167 recognised accidental dural punctures after epidurals (0.91%), with 147 patients (88%) developing post dural puncture headache. In addition there were 52 post dural puncture headaches after subarachnoid blocks (1.04%). Successful management of accidental dural puncture and post dural puncture headache requires adherence to clear policies and protocols, with close follow-up of patients by an experienced obstetric anaesthetist.
Collapse
Affiliation(s)
- J S Sprigge
- Arrowe Park Hospital, Upton, Wirral, CH49 5PE, UK.
| | | |
Collapse
|
28
|
Zada G, Solomon TC, Giannotta SL. A review of ocular manifestations in intracranial hypotension. Neurosurg Focus 2007; 23:E8. [DOI: 10.3171/foc-07/11/e8] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Object
Intracranial hypotension (ICH) can present with a wide variety of visual symptoms and findings. Deficits in visual acuity and visual fields as well as ophthalmoplegia due to cranial nerve dysfunction have been frequently described. The aim of this review was to identify the most commonly reported ocular manifestations associated with ICH.
Methods
The authors conducted a review of the literature to date to identify all studies of patients with ICH and ocular manifestations.
Results
The most commonly encountered cranial nerve deficit resulting from ICH (> 80% of reported cases) is an abducens nerve paresis, which may occur unilaterally or bilaterally. Although less common, oculomotor and trochlear nerve palsies have been reported as well. The optic nerve complex is frequently involved in ICH and may manifest as deficits in visual acuity and field cuts. Visual deficits and ophthalmoplegia improved following appropriate management in 97% of reported cases.
Conclusions
Intracranial hypotension can present with a wide spectrum of visual deficits, the causes of which are multifactorial. Cranial nerve paresis, especially of the abducens nerve, is frequently reported. The majority of symptoms and cranial nerve deficits reviewed respond favorably to conservative management, epidural blood patch administration, or in a minority of cases, surgical intervention.
Collapse
|