Details

Autor(en) / Beteiligte

• Simic, Svetlana S
• Kopitovic, Aleksandar S
• Zikic, Tamara Rabi
• Knezevic, Jelena
• Radmilo, Ljiljana
• Simic, Dragan S

Titel

POST-DURAL PUNCTURE HEADACHE: EPIDEMIOLOGY, ONSET MECHANISMS, CLINICAL SYMPTOMS, DIAGNOSIS AND THERAPY/GLAVOBOLJA NASTALA POSLE DURALNE PUNKCIJE--EPIDEMIOLOGIJA, MEHANIZAM NASTANKA, KLINICKA SLIKA, DIJAGNOZA I TERAPIJA

Ist Teil von

• Medicinski pregled, 2019-11, Vol.72 (11-12), p.383

Ort / Verlag

Drustvo Lekara Vojvodine

Erscheinungsjahr

2019

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• Introduction. Post-dural puncture headache is classified as a secondary headache attributable to non-vascular intracranial disorders and belongs to the group of headaches caused by low cerebrospinal fluid pressure. Etiopathogenesis. The pathogenesis is not completely clear, but it is thought to be caused by the cerebrospinal fluid leak through the duct opening. Cerebrospinal fluid efflux leads to a decrease in intracranial pressure and stretching of the pain sensitive intracranial structures. A drop in intracranial pressure can cause compensatory cerebrovascular vasodilation, contributing to the onset of a headache. Diagnosis and Therapy. Post-dural puncture headache clinically presents as an orthostatic headache. In most cases, the diagnosis is made based on a typical clinical picture and it can be confirmed by magnetic resonance imaging and measurement of cerebrospinal fluid pressure. The condition is usually benign, most often with spontaneous recovery. The therapy involves conservative treatment, medications, as well as some invasive methods: epidural blood patches, blockage of the greater occipital nerve, and in most severe cases, epidural injection of fibrin sealant or surgical dural repair. Conclusion. Post-dural puncture headache is a common complaint in the clinical practice of neurologists and anesthesiologists. The prognosis is usually favourable, while the therapy may include conservative or invasive treatment procedures. Key words: Post-Dural Puncture Headache; Headache Disorders, Secondary; Cerebrospinal Fluid Leak; Intracranial Pressure; Blood Patch, Epidural; Intracranial Hypotension; Hypotension, Orthostatic; Spinal Puncture; Headache Sazetak Uvod. Glavobolja nakon punkcije dure je svrstana u sekundarnu glavobolju koja se pripisuje nevaskularnim intrakranijalnim poremecajima i nalazi se u grupi glavobolja koje se pripisuje niskom pritisku likvora. Etiopatogeneza. Patogeneza nije u potpunosti jasna, a smatra se da je uzrokovana odlivanjem cerebrospinalne tecnosti kroz otvor na duri. Odlivanje likvora dovodi do smanjenja intrakranijalnog pritiska i istezanja na bol osetljivih intrakranijalnih struktura. Pad intrakranijalnog pritiska moze izazvati kompenzatornu cerebrovaskularnu vazodilataciju, sto doprinosi razvoju glavobolje. Dijagnoza i terapija. Klinicki se prezentuje kao ortostatska glavobolja. Dijagnoza se u vecini slucajeva postavlja na osnovu tipicne klinicke slike, a moze se potvrditi magnetnom rezonancijom i merenjem pritiska likvora. Tok je obicno benigan sa najcesce spontanim oporavkom. U terapiji se mogu primeniti konzervativne mere lecenja, medikamenti i invazivne metode u vidu epiduralne krvne zakrpe, blokade velikog okcipitalnog nerva, a u najtezim slucajevima primenjuje se epiduralna injekcija fibrinskog lepka ili hirurska reparacija dure. Zakljucak. Glavobolja nakon punkcije dure je cesta zalba sa kojom se susrecu neurolozi i anesteziolozi u klinickoj praksi. Prognoza je obicno povoljna. U terapiji se mogu primeniti konzervativne i invazivne mere lecenja. Kljucne reci: glavobolja nakon duralne punkcije; sekundarne glavobolje; curenje cerebrospinalne tecnosti; intrakranijalni pritisak; epiduralne krvne zakrpe; intrakranijalna hipotenzija; ortostatska hipotenzija; spinalna punkcija; glavobolja