Postdural puncture headache as a complication of lumbar puncture: clinical manifestations, pathophysiology, and treatmen
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REVIEW ARTICLE
Postdural puncture headache as a complication of lumbar puncture: clinical manifestations, pathophysiology, and treatment Srdjan Ljubisavljevic 1,2 Received: 24 May 2020 / Accepted: 23 September 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Objective This manuscript is a narrative review of peer-reviewed studies of postdural puncture headache (PDPH) as the most common complication of a diagnostic and therapeutic lumbar puncture (LP) and LP due to the damage of the dura mater in epidural anesthesia. Methods Author searched articles related to the PDPH and its risk factors, pathophysiology diagnosis, differential diagnosis, and therapy. All studies according to the analyzed parameters and their relevance to the clinical practice, as well as quality of the study methods, were selected for further analysis. Results The review presents the clinical and paraclinical prediction criteria for the onset, clinical features, course, and efficiency of specific therapeutic interventions which are of a particular clinical benefit for the prevention, pathogenetic treatment, and differential diagnosis of PDPH. The analysis of prediction parameters for the onset, clinical course, and associated symptoms and signs of PDPH is a contribution to the understanding of pathophysiology of intracranial hypotension, since PDPH can be considered a clinical model of intracranial hypotension. Conclusions Given that LP is a common procedure in clinical practice, it is necessary to have a comprehensive knowledge of the risk factors, pathophysiological, diagnostic, differentially diagnostic, and therapeutic aspects of PDPH. Keywords Lumbar puncture . Headache
Lumbar puncture complications Lumbar puncture (LP) is the process of inserting a needle into subarachnoid space (SAS) in lumbar cistern for diagnostic purposes (measuring cerebrospinal fluid (CSF) pressure, sampling CSF for laboratory analysis, and applying contrast agents for radiological imaging, etc.) and/or for therapeutic reasons [1]. LP complications are not uncommon. They occur in more than half of patients. Most often, they manifest with local discomfort or pain at the needle application site. The use of a smaller-sized atraumatic needle and the success of the LP
* Srdjan Ljubisavljevic [email protected] 1
Department for Neurology, Faculty of Medicine, University of Nis, Nis, Serbia
2
Department for Cerebrovascular Diseases and Headache, Clinic for Neurology, Clinical Center of Nis, Blvd. Dr Zorana Djindjica 81, Nis 18000, Serbia
without repeated attempts or repositioning of the needle directly reduce these complications. Patients with osteodegenerative diseases often experience a higher number of LP attempts, a higher incidence of traumatic LP, and inability to sample CSF. Multiple attempts lead to spasm of the paravertebral musculature. The occurrence of disc prolapse after LP was also described [1–3]. Some patients may experience low back pain or pain in the radicular distribution of a particular lumbar or sacral nerve. If this pain is sustaine
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