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Post-puncture syndrome is a complex of symptoms that is a complication after a lumbar puncture. This procedure is performed to diagnose the cerebrospinal fluid or to perform epidural or spinal anesthesia. Women, especially pregnant women, are more exposed to it.

Post-puncture syndromehas an unknown etiology. The main cause of its appearance is probably a decrease in the pressure of the cerebrospinal fluid. The reduction occurs not only as a result of collecting the cerebrospinal fluid for examination, but also after puncture without collection, which is related to the persistence of fluid leakage at the dural puncture site. Such a loss may be up to 158 ml.

One theory is that the onset of symptoms is the result of displacement of intracranial structures resulting in compression and pulling on pain-sensitive structures such as blood vessels or dural sinuses.

Another theory explains the pain caused by the expansion of intracranial blood vessels, which is the result of the mechanism of compensation for the decrease in pressure inside the skull caused by the decrease in the volume of the cerebrospinal fluid.

Post-Functional Syndrome: Symptoms

  • severe headache

Typically symptoms of post-dural syndrome appear within 24-48 hours. from puncture. However, there have been reports of headaches that meet the criteria for the diagnosis of the post-dysfunctional syndrome up to 14 days.

  • dizziness
  • feeling lightheaded
  • scalp paraesthesia
  • visual disturbance (including photophobia)
  • neck stiffness
  • feeling sick
  • vomiting
  • back pain
  • pain in the arms and lower limbs
  • partial hearing loss
  • cerebral nerve palsy

The duration of symptoms in about 70% is 7 days, but in individual cases even months. The dominant symptom is a blunt headache located in the frontal and / or occipital area - bilateral in 2/3 of the cases, and unilateral in the remaining cases. Pain is related to the position of the body - it intensifies when standing and during pressure with the abdominal muscles. Nausea is the most common comorbid symptom (in 85% of cases).

Post-operative syndrome: differentiation

In an accidentheadache suggesting a post-dural syndrome, the following occurrence should be considered in the differential diagnosis:

  • hematoma or subarachnoid hydrocele - if the symptoms were delayed
  • meningitis (rarely)
  • idiopathic syndrome with decreased cerebrospinal fluid pressure - identical symptoms occur, but are not preceded by puncture of the subarachnoid space

Post-function syndrome: treatment

The treatment used for a long time was symptomatic and did not work well. Analgesics were administered, fluid intake was increased, and bed rest was recommended. Currently, in severe cases, where conservative treatment is ineffective, a blood patch is applied to the epidural space. For this purpose, 10-20 ml of blood are collected under aseptic conditions and injected into the epidural space at the site of the previously performed puncture. The patient should lie on their back for 1-2 hours for the blood to clot at the injection site. 90% of the symptoms disappear after the first patch. If the pains reappear, the blood injection can be repeated after 24 hours.

Post-Duty Team: Prevention

  • not performing spinal anesthesia in patients with a history of severe headaches
  • use of the thinnest core needles possible (25.26 or 27G), and in young patients use pencil-point needles, because the younger the patient and the thicker the needle, the more frequent the post-puncture syndrome
  • multiple punctures of the dura mater in order to enter the subarachnoid space are not allowed
  • during puncture, the hole in the puncture needle should point to the side
  • re-insert the stylet into the puncture needle before removing it
  • 24-hour bed rest is unnecessary, as it does not affect the occurrence of post-puncture headaches

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Category:

Neurology