A simple treatment of post-lumbar-puncture headache

Lumbar puncture and post-dural puncture headaches: implications for the emergency physician

Lumbar puncture is a diagnostic procedure commonly performed by emergency physicians. Post-dural puncture headaches occur frequently after this procedure and can be associated with significant morbidity and, occasionally, even death. There is also a lot of variation in how post-dural puncture headaches are treated once they occur. This article seeks to examine the science behind post-dural puncture headaches, their prevention and treatment.

Syndrome of cerebrospinal fluid hypovolemia following lumbar puncture cerebrospinal fluid leak in a patient with idiopathic intracranial hypertension

An 11-year-old girl presented with headache of 3 months' duration. There was bilateral disc edema. The cerebrospinal fluid pressure was 50 cm of water with normal cerebrospinal fluid cytology and biochemistry. She developed severe headache (different and disabling), dizziness, vomiting, and backache on sitting up 6 hours after lumbar puncture, and lying supine relieved all of her symptoms. Intravenous fluids, analgesics, and complete bed rest did not relieve her symptoms over the next 72 hours. She was completely relieved of her symptoms on receiving two tablets of Caffergot containing 200 mg of caffeine and 2 mg of ergotamine 72 hours after lumbar puncture. The symptoms recurred 48 hours later, and a repeat dose of Caffergot was required. Magnetic resonance imaging (MRI) done 96 hours after lumbar puncture revealed the entire dura overlying the brain, including the posterior fossa, showing intense enhancement on contrast injection with leak at the lumbar puncture site. Oral caffeine (coffee, three times a day) was advised over 1 week. The patient remained asymptomatic, and a repeat MRI scan after 10 days showed complete clearing of the cerebrospinal fluid leak with no dural enhancement. The syndrome of cerebrospinal fluid hypovolemia following lumbar puncture is reported in a girl with idiopathic intracranial hypertension.

Patient care after discharge from the ambulatory surgical center

An important and often forgotten aspect of postoperative care occurs after the patient is discharged from the ambulatory surgical center. With more than 60% of all surgeries and procedures occurring on an ambulatory basis, what happens after the patient is no longer in continuous professional care is of concern to the ambulatory nurse. Numerous physical postoperative complaints are common and expected sequelae of anesthesia and surgery in the ambulatory patient. In this article, important postdischarge complications are reviewed and contemporary management options discussed. The information contained in this review article is valuable to the provider in educating patients regarding their anticipated course of postoperative recovery.

OBJECTIVES

-Based on the content of this article, the reader should be able to (1) identify important postdischarge complications to provide patients with comprehensive discharge instructions regarding their continued recovery at home; (2) discuss contemporary management options available to treat postdischarge complications; (3) realize the incidence of specific postdischarge complications and how that relates to patient satisfaction with the surgical experience; (4) recognize signs and symptoms of postdischarge complications; and (5) identify risk factors of patients for developing specific complications in the postoperative phase.

Perils and pitfalls of lumbar puncture in the emergency department

Lumbar Puncture is a procedure commonly performed in the emergency department. It provides important diagnostic information but has a significant number of limitations and complications. This article reviews the role of lumbar puncture in the emergency department based on an extensive review of the current literature, focusing on the recognized contraindications and complications of the procedure and how they can be minimized. The interpretation of diagnostic tests performed on cerebrospinal fluid is also examined, highlighting those tests most commonly ordered from the emergency department.

Post dural puncture headache

We describe the delayed diagnosis and management of a spinal headache following the use of a 24 g Sprotte needle, the results of a survey of spinal needle usage by physicians in the south west of England and a review of the prevention and management of postdural puncture headache.

The contribution of needle size and other factors to headache following myelography

The author performed a randomized prospective study of the effects of needle size and of age, sex, myelogram type and operators on the incidence of headache following myelography. In 113 patients randomized to 22 G and 25 G needle groups, data were obtained by questionnaire on the frequency of headache up to five days following the procedure. The influence of needle size was statistically insignificant (63%, 48%, p > 0.05). Age (p = 0.0002), sex (p = 0.01), myelogram type (p = 0.002) and myelographer (p = 0.03) significantly affected the frequency of headache. The size of the dural perforation appears to be less important than factors relating to age, sex, myelogram type and individual myelographers in the development of headache after myelography.