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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, April 1, 2014

Cefalea post PL

31 MAR 2014 - R.E.B.E.L. EM
"Lumbar puncture is a procedure that is commonly performed in the emergency department (ED) for both diagnostic and therapeutic reasons. Post lumbar puncture (LP) headache is one of the most common complications from LPs (6 – 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated symptoms. Additionally, post LP headaches that are left untreated can cause impaired ability to perform activities of daily living and there are case reports of subdural hematoma, herniation, and death. In terms of the prevention and treatment of post-LP headaches, both are equally important in management. Following, is a discussion of which techniques and preventative measures are evidence based and which are not.

Take Home Messages:
What Helps Prevent Post LP Headaches:
  • 20 – 22G needles seems to be the optimal size for diagnostic/therapeutic LPs in adults
  • Needle bevel parallel to dural fibers
  • Replacement of stylet before withdrawal of spinal needle
  • Early ambulation, NOT laying flat post procedure
  • Number of LP attempts (Never studied, but pathophysiologically makes sense)
What DOES NOT Help Prevent Post LP Headaches:
  • Volume of CSF removed
  • Patient Position
  • IVF prior to LP
  • Oral hydration after lumbar puncture does not improve treatment (would like to see a study with IVF)
  • The evidence is weak, but IV or oral caffeine does improve post LP headache, but with a high recurrence rate
  • Blood patch is an effective treatment for post LP headache"