PDPH - Post-Dural Puncture Headache Dmitry Portnoy, MD...

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Post-Dural Puncture Headache Dmitry Portnoy, MD Anesthesiology Department UTMB
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First PDPH experienced and described Dr. August Bier in 1898 who stated All these symptoms ( pressure in the head, dizziness ) dissappeared as soon as I lay down horizontally, but they returned when I arose” MacRobert RG : The cause of lumbar puncture headache. J Am Med Assoc 1918; 70:1350
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Pathophysiology: CNS and CSF CSF production - 500 ml/day to maintain 150 ml. CSF pressure from 5 to 15 cm H20 up to 40 cm in upright position CSF leakage (higher in upright position) Pressure gradient increased Traction on and stretching pain-sensitive structures
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Pathophysiology: Independent Factors Gender ( female >> male) Pregnancy Age ( decreased incidence with increasing age) Psychosomatic component Needle size and design Technique of needle insertion Previous history of PDPH
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Clinical presentation of PDPH Postural nature of the headache is the hallmark. Throbbing pain in frontal or occipital areas. Onset typically within 24 to 48 hours. Associated symptoms: neck stiffness and scapular pain nausea, vomiting, vertigo, dizziness photophobia, diplopia hearing loss, tinnitus
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Clinical presentation of PDPH: Severity Mild PDPH (VAS score 1 - 3) slight restriction of daily activities the patient is not bedridden, no associated symptoms Moderate PDPH (VAS score 4-7) significant restriction of daily activities
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PDPH - Post-Dural Puncture Headache Dmitry Portnoy, MD...

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