Failure of postural manoeuvres to prevent lumbar puncture headache.

Hilton‐Jones, David; Harrad, R A; Gill, M W; Warlow, Charles

doi:10.1136/jnnp.45.8.743

Cited by 43 publications

(6 citation statements)

References 12 publications

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“…Similarly, because we did not require rest in the supine position after LPs, we could not evaluate the potential influence of this intervention. Other studies have found that rest after LP does not prevent PDPH 24‐27 . All LPs in our study were performed with 22‐gauge, atraumatic needles, as opposed to the traditional, cutting‐edge (Quinke) needle.…”

Section: Discussionmentioning

confidence: 94%

Incidence of Post-Dural Puncture Headache in Research Volunteers

Almeida¹,

Shumaker²,

LeBlanc³

et al. 2011

Headache: The Journal of Head and Face Pain

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Objective To determine the frequency and risk factors of post-dural puncture headache (PDPH) in research volunteers. Background Despite increasing interest in measuring cerebrospinal fluid biomarkers to investigate disease pathogenesis and diagnosis, previous case series have evaluated lumbar puncture (LP) safety only in clinical care. PDPH is a common complication after LP. Methods We determined the frequency of post-dural puncture headache (PDPH) in neurologically unselected HIV seropositive and seronegative adults volunteering for research, as well as the variables associated with the development of (PDPH). Variables studied were BMI, HIV serostatus, volume of CSF removed, number of previous LPs, use of pre-medication, LP position, lumbar space, number of needle passes, whether or not aspiration was used, CSF WBC, CSF RBC, CD4 count, CD4 nadir, CSF HIV viral load, plasma HIV viral load, and race. Results Of 675 LPs performed over one year, headache developed in 38 (5.6%; 95% CI 4.2, 7.1)). Most PDPH (92%) resolved spontaneously or with conservative medical management; 3 required epidural blood patch. Greater headache risk was associated with lower body mass index (BMI ≤ 25 versus > 25) (OR 3.3; CI 95% 1.5, 7.0; p=0.001) and less prior LP experience (previous LPs ≤ 2 vs > 2) (OR 2.1; CI 95% 1.1, 4.1; p=0.03). PDPH was not significantly (p > .05) related to HIV serostatus, CSF volume, or gender. Conclusion In this study, where tolerance to risk was low because LPs were done for research rather than clinical purposes and healthy controls were included, adverse effects were mild and self-limited.

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Section: Discussionmentioning

confidence: 94%

Incidence of Post-Dural Puncture Headache in Research Volunteers

Almeida¹,

Shumaker²,

LeBlanc³

et al. 2011

Headache: The Journal of Head and Face Pain

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show abstract

“…Manual review of abstracts and/or full texts identified 22 unique references evaluating the relationship between CSF volume and/or pressure measurements and PDPH incidence (Fig. ) . The references included analysis of V (n = 14), OP (n = 11) and/or CP (n = 4) (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Alpers felt a relationship between elastance and PDPH existed, but did not conduct a formal comparison . Hilton‐Jones et al comments on the mean change in pressure after removal of 10 mL of CSF as statistically similar in patients with and without headache . Therefore, both Alpers and Hilton‐Jones evaluated E, although did not comment on it by name.…”

Section: Discussionmentioning

confidence: 99%

CSF Pressure, Volume, and Post‐Dural Puncture Headache: A Case‐Control Study and Systematic Review

et al. 2019

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Objectives (1) To perform a systematic literature review to evaluate associations between post‐dural puncture headache (PDPH) and opening pressure (OP), closing pressure (CP), and volume of cerebrospinal fluid (V) removed. (2) To perform a case‐control study to evaluate pressure‐volume index (PVI) as a novel risk factor for PDPH. Background According to the International Classification of Headache Diagnoses, 3rd Edition (ICHD‐3), the diagnosis of PDPH requires documentation of intracranial hypotension. However, this remains an unproven concept. Methods A systematic literature review was conducted, searching Cochrane Database of Systematic Reviews, Ovid EMBASE, OVID MEDLINE, Scopus, and Web of Science. Study inclusion required a comparison of headache incidence following a LP as a function of OP, CP, and/or V. A retrospective, case‐control study with 1:1 matching was conducted utilizing ICHD‐3 criteria. Patients with factors that could influence CSF pressure were excluded. Results In our case‐control study, we did not identify a paired difference in either median (95% CI) elastance (0.05 [−0.09, 0.11], P = .503) or PVI (4.53 [−7.98, 19.97], P = .678). We identified 22 references, evaluating V (n = 14), OP (n = 11), and/or CP (n = 4). There was no convincing evidence for an association of PDPH with either OP or CP. A minority of studies documenting an association with V included patients with high‐volume CSF removal, and/or stratified patients by the timing of the headache onset. Conclusions The overall risk of PDPH does not appear to be influenced by OP, CP, V or PVI. PDPH may be related to V in instances of high‐volume removal, and depend on the timing of outcome assessment. Future revision of criteria should consider the existence of immediate and delayed PDPH subtypes, and not presume intracranial hypotension as a mandatory feature.

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“…PLPHA is related to a number of factors, including young age, female gender, headache history, small body mass index and pregnancy (10). Despite these uncontrollable factors, there are also some variables which can influence the incidence of PLPHA such as needle size (should be less than 20 gauge), bevel orientation and the number of dural punctures (11)(12)(13). The position of the patient after LP, the volume of fluid removed during LP and hydration following LP have all been found to affect the incidence of PLPHA (10,13,14).…”

Section: Discussionmentioning

confidence: 99%

Headache and Meningismus Following Lumbar Puncture

Bektaş¹,

Söyüncü²

2012

JAEMCR

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Post-lumbar puncture headache is the most common complication of lumbar puncture. This condition is thought to be the result of persistent cerebrospinal fluid leakage at the puncture site, leading to low cerebrospinal fluid pressure and traction on the meninges and intracranial veins. Associated symptoms may include nausea, vomiting, auditory and vestibular symptoms. Meningeal irritation signs are unexpected as clinical findings unless serious medical conditions such as subarachnoid hemorrhage or meningitis occur. We are present a case of headache and meningismus following by lumbar puncture. A 17-year-old female presented to the emergency department suffering from headache, nausea and vomiting, starting one day after a lumbar puncture procedure. The characteristics of the headache were different and more severe than the previous form. Her vital signs and physical and detailed neurological examination were normal, except meningismus findings such as neck stiffness and Brudzinksy's sign. Since the meningismus findings were unexpected, lumbar puncture was performed again to diagnose meningitis and subarachnoid hemorrhage. Cerebrospinal fluid pressure, protein, glucose, microscopic examination, blood and cerebrospinal fluid cultures were normal. Finally, magnetic resonance imaging of the brain revealed no pathological meningeal enhancement. In patients harboring uncontrollable factors, variables such as needle size, bevel orientation and the avoidance of traumatic lumbar puncture should be taken into consideration more seriously than ever. Furthermore, since, meningeal irritation signs such as neck stiffness and Brudzinksy's and Kernig's signs are not the expected clinical findings of post-lumbar puncture headache, serious medical conditions such as subarachnoid hemorrhage and meningeal infections should be investigated in the emergency setting.

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Failure of postural manoeuvres to prevent lumbar puncture headache.

Cited by 43 publications

References 12 publications

Incidence of Post-Dural Puncture Headache in Research Volunteers

Incidence of Post-Dural Puncture Headache in Research Volunteers

CSF Pressure, Volume, and Post‐Dural Puncture Headache: A Case‐Control Study and Systematic Review

Headache and Meningismus Following Lumbar Puncture

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