Başak KARAKURUM GÖKSEL, Naime ALTINKAYA, Anıl TANBUROĞLU, Mehmet KARATAŞ

Post-dural ponksiyon baş ağrısının geç dönem rekürensi

Postdural ponskiyon başağrısı (PDPB) kazara yapılan dural yırtığın en sık rastlanan komplikasyonudur. Tanısal semptomu aya- ğa kalkınca veya oturunca başlayan, yatınca düzelen postural baş ağrısıdır. Bu semptom, BOS göllenmesi sonucu BOS basınç veya volüm düşüklüğü ile ortaya çıkar. Ayağa kalkınca ağrıya duyarlı yapıların traksiyonu, intrakraniyal içeriğin şifti postural baş ağrısına yol açar. PDPB genellikle kendini sınırlayan, 2 hafta içinde kendiliğinden düzelen bir tablodur. Daha az sıklıkla epidural kan yamasına ihtiyaç duyulur. Spontan intrakraniyal hipotansiyonun tekrarlaması nadir değildir, ancak PDPH spontan ve geç dönemde rekürensi oldukça nadir rapor edilmiştir. Bu yazının amacı epidural kan yamasından sonra düzelip, 10 ay sonra pos- tural baş ağrısı tekrarlayan olguyu tartışmaktır.

Late recurrence of post-dural puncture headache

The term post-dural puncture headache (PDPH) refers to a common complication that occurs after accidental dural puncture. One of the diagnostic symptoms of PDPH is a postural headache, which worsens dramatically while sitting or standing and is relieved mostly by lying down. This symptom is caused by a cerebrospinal fluid (CSF) leak, leading to decreased CSF pressure or low CSF volume, which provokes a shift of intracranial contents and traction on pain-sensitive structures in the upright posi- tion. PDPH is commonly a self-limited condition and remits spontaneously within 2 weeks, or becomes less severe after surgi- cal intervention to seal the leak with autologous epidural blood patch (EBP). Although recurrence of spontaneous intracranial hypotension following an EBP is not rare, spontaneously late recurrence of PDPH has been rarely reported. The purpose of this paper is to discuss this case with late recurrence of PDPH after 10 months following EBP.

PDF

___

1. Lin JP, Zhang SD, He FF, Liu MJ, Ma XX. The status of diag- nosis and treatment to intracranial hypotension, including SIH. J Headache Pain 2017;18(1):4.
2. Kranz PG, Gray L, Amrhein TJ. Spontaneous intracranial hypotension: 10 myths and misperceptions. Headache 2018;58(7):948–59.
3. Ghaleb A, Khorasani A, Mangar D. Post-dural puncture headache. Int J Gen Med 2012;5:45–51.
4. Headache classification committee of the interna- tional headache society (IHS) The international classi - fication of headache disorders, 3 rd edition. Cephalalgia 2018;38(1):102–3.
5. Bezov D, Lipton RB, Ashina S. Post-dural puncture head - ache: Part I diagnosis, epidemiology, etiology, and patho- physiology. Headache 2010;50(7):1144–52.
6. Sachs A, Smiley R. Post-dural puncture headache: The worst common complication in obstetric anesthesia. Se- min Perinatol 2014;38(6):386–94.
7. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006;295:19.
8. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks: A review. Neurosurg Focus 2000;9(1):e8.
9. Kuczkowski KM. Once a post-dural puncture headache patient-always post-dural puncture headache patient: An update. Acta Anaesthesiol Belg 2005;56(1):23.
10. Pirbudak L, Uğur MG, Kaya Uğur B, Kul S, Ganidağlı S. Eval- uation of affecting factors and the effectiveness of treat- ment in cases with post-dural puncture headache who underwent epidural blood patch. Agri 2014;26(3):101–6.
11. Monserrate AE, Ryman DC, Ma S, Xiong C, Noble JM, Ring- man JM, et al. Factors associated with the onset and per - sistence of post-lumbar puncture headache. JAMA Neurol 2015;72(3):325–32.
12. Ahmed SV, Jayawarna C, Jude E. Post lumbar puncture headache: Diagnosis and management. Postgrad Med J 2006;82(973):713–6.
13. Robbins KB, Prentiss JE. Prolonged headache after lumbar puncture. Successful treatment with an epidural blood patch in a 12-year-old boy. Clin Pediatr 1990;29(6):350–2.
14. Wilton NC, Globerson JH, de Rosayro AM. Epidural blood patch for post-dural puncture headache: It’s never too late. Anesth Analg 1986;65(8):895–6.
15. Sidebotham D, Willoughby E, Schug SA. Late recurrence of postdural puncture headache. Reg Anesth 1997;22(4):382–4.
16. Albayram S, Gündüz A, Işık Z. Can Ramadan fasting cause relapse and aggravation of spontaneous intracranial hypo- tension? Agri 2013;25(1):44–6.