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Outline the treatment for postdural puncture headache.
Postdural puncture headache (PDPH) can occur any time the dura is punctured. Persistent cerebrospinal fluid (CSF) leak decreases the amount of fluid available to cushion the brain. In the absence of an adequate fluid buffer, the brain shifts within the calvarium, placing tension on pain-sensitive blood vessels. Risk factors for PDPH include increasing size of needle, type of needle (lower with pencil-point needles), bevel perpendicular to dural fibers (for non-pencil-point needles), female gender, pregnancy, and increasing number of attempts.
The headache is classically located over the occipital or frontal regions. It is frequently accompanied by neck ten-sion, tinnitus, diplopia, photophobia, nausea, and vomit-ing. The most diagnostic feature of PDPH is that it changes with position. The symptoms improve in the supine posi-tion and are exacerbated in the erect position (sitting or standing).
Treatment is divided into noninvasive and invasive measures. Noninvasive therapy includes analgesics, hydra-tion, and caffeine. Invasive therapy involves placing an epidural blood patch. This is accomplished by sterilely injecting 20 mL of autologous blood into the epidural space. The success rate is 70â€“75%. A second blood patch is needed occasionally. Prophylactic blood patching or pro-phylactic epidural saline infusions to reduce the incidence of PDPH are controversial.
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