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What is Postdural Puncture Headache?
Postdural punctureheadacheis often terrible and localized over back of the foreland . The Postdural puncture headache is also known as occipital headache . The quality of postdural puncture headache is throbbing and uninterrupted . Headache does not react to pain medications . Postdural puncture cephalalgia is due to continuous leak of cerebrospinal fluid from laceration , crack or hole in dural tissue layer . The three tissue layer report brain and Spinal cord . Cerebrospinal fluid lies between 2nd and 3rd stratum of tissue layer , also known as mater . The 3 membranes are known as Indian arrowroot , arachnoid and dura mater . The CSF is also find in heart ventricle within the psyche tissue paper in increase to subarachnoid space , which environ brain andspinal cord . The three membrane which surround brain also continues around spinal cord . The space which contains cerebrospinal fluid Trygve Lie between Indian arrowroot and arachnoid mater and know as subarachnoid place . There is no space between Tacca pinnatifida mater and spinal cord , pia mater is closely attached to spinal cord . likewise , there is no place between arachnoid and dura mater , since both the membrane are closely adhered to each other .
What is Dural Puncture?
Dural puncture go on when MD attempts to perform operation or operation close to extradural blank , subarachnoid space or spinal cord . The dural laceration or puncture are due to tart operative pawn or tip of the acerate leaf . The structural damage of aerofoil of dura also admit arachnoid tissue layer , since both the tissue layer are adhered to each other . Thus any laceration or incursion of dura also causes cracking or hole in arachnoid membrane that results in photo of subarachnoid outer space . So , puncture of dura expose the subarachnoid space to epidural outer space . Even tiny photograph of subarachnoid infinite cause by tip of thin spinal needle solution in cerebrospinal fluid passing water in to extradural space . The slow or rapid loss of cerebrospinal fluid from subarachnoid space follow serious headache . Such headache triggered by dural puncture is known as Postdural puncture headache . The exit of cerebrospinal fluid decreases pressure within subarachnoid space , which is convey with symptom like stark pounding headache . Dural puncture can be modest or major .
What Causes Postdural Puncture Headache?
The subarachnoid space around spinal corduroy is also connected tobrain . Loss of cerebrospinal fluid following uninterrupted leak through puncture or lacerated dural cracks and decreases the pressure within the subarachnoid space besiege spinal electric cord and brainpower . Thus the cliff of pressure within subarachnoid space is observed in spinal corduroy as well as brain . Sudden drop of pressure within subarachnoid quad covering wit which is enclosed in skull also affects the precis of vessels like arteries , veins and lymphatics . These watercraft around the brain swell up within skull to occupy the expiration of space created by loss of brain CSF . The increased sizing of pulsating vessels within wit causes pound up and throbbing vexation .
How is Postdural Puncture Headache Diagnosed?
account of Headache - The history of severe headache , which begin 2 to 3 hours after back surgical procedure , spinal anaesthesia or epidural procedure advise potential causal agency of headache could be dural puncture or laceration . likewise , story of severe headache come after workplace or auto fortuity resulting in blunt or penetrating back hurt suggest possible dural injury . The history of headache also suggests loudness of post spinal headache become severe in sitting or standing position . Headache subsides or strength decreases when patient lies down supine .
Diagnostic Lumbar Puncture - The symptomatic lumbar puncture procedure involves placing the needle in subarachnoid infinite and then checking the CSF pressure . The pressure in subarachnoid infinite is checked following placing the tiny 22 to 25 - bore spinal needle in lumbar subarachnoid place . The paired end of the needle is connected to manometer to checker the press . at the same time biochemical test is performed to check CSF protein and lymph cell count . The loss of CSF induce increased concentration of CSF protein and lymphocytes count .
Magnetic Resonance Imaging ( MRI)-MRI subject field of brain and spinal cord is performed . The midget needle puncture over dura is often not observed in MRI films and effigy . MRI of the brain suggests diffuse dural enhancement and sagging of the dural covering around brain . The film also indicate obliteration of basilary cisterns and enlargement of pituitary gland.2
How is Postdural Puncture Headache Treated?
Treatment of Minor Postdural Puncture Headache-
Continuous Flow of Epidural Saline - The recent published clause indicate substitute to blood patch is to localise a catheter in epidural space and interject 6 milliliter of normal saline per hour.3The volume injected matches the book loss resulting in balance the pressure . The treatment for postdural puncture headache may last for 2 to 3 day and gives time to heal the wound .
Treatment of Postdural Puncture Headache Caused By Major Laceration
Surgical Repair - Postdural Puncture Headache caused due to major laceration can not be plow with descent patch . The uninterrupted leakage causes severe loss of cerebrospinal fluid resulting in uninterrupted head ache . The treatment alternative for postdural puncture headache due to major laceration is operative repair of dural tear .
character reference
A short review on a complicatedness of lumbar spikelet operating room : CSF escape . Menon SK1 , Onyia CU2.Clin Neurol Neurosurg . 2015 Dec;139:248 - 51.https://www.ncbi.nlm.nih.gov / pubmed/?term=1.%09A+short+review+on+a+complication+of+lumbar+spine+surgery%3A+CSF+leak.+Menon+SK1%2C+Onyia+CU2.+Clin+Neurol+Neurosurg.+2015+Dec%3B139%3A248 - 51.+doi%3A+10.1016%2Fj.clineuro.2015.10.013.+Epub+2015+Oct+23 .
Post lumbar puncture headache : diagnosis and managements . randomness V Ahmed , C Jayawarna , and E JudePostgrad Med J. 2006 Nov ; 82(973 ): 713–716.https://www.ncbi.nlm.nih.gov / pubmed/?term=1.%09Post+lumbar+puncture+headache%3A+diagnosis+and+managements.+S+V+Ahmed%2C+C+Jayawarna%2C+and+E+Jude+Postgrad+Med+J.+2006+Nov%3B+82(973)%3A+713–716 .
uninterrupted epidural pumping of saline contributes to prevent and treat postPostdural puncture headache . Che X1 , Zhang W2 , Xu M2.J Clin Anesth . 2016 Nov;34:154 - 8.https://www.ncbi.nlm.nih.gov / pubmed/?term=1.%09Continuous+epidural+pumping+of+saline+contributes+to+prevent+and+treat+postdural+puncture+headache.+Che+X1%2C+Zhang+W2%2C+Xu+M2.++J+Clin+Anesth.+2016+Nov%3B34%3A154 - 8
