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European Radiology

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01-04-2014 | Neuro

Incidental findings of CSF leakage in patients without spontaneous intracranial hypotension and development of post-dural puncture headache

Authors: Saeed Fakhran, Stacy Palfey, Andrew Thomas, Samuel Schwarz, Lea Alhilali

Published in: European Radiology | Issue 4/2014

Abstract

Objectives

To determine if nerve root sleeve diverticula or CSF leakage correlate with post-dural puncture headache (PDPH).

Methods

A total of 781 lumbar and 408 cervical post-myelogram CTs were reviewed using a total diverticulum and leakage (TDL) score: 1, nerve root sleeve diverticulum not beyond the lateral vertebral body; 2, diverticulum beyond the lateral vertebral body; 3, periradicular contrast; 4, epidural contrast medium collection. Two scores at each level (left, right) were added for a total score. Results were correlated with post-procedure follow-up.

Results

PDPH occurred in 22 (2.8 %) lumbar and 15 (3.7 %) cervical patients. Iodine concentration was not significantly different in lumbar (P = 0.14) or cervical (P = 0.85) patients with or without PDPH. Total scores correlated with PDPH after lumbar (P < 0.0001) and cervical (P < 0.0001) myelography. PDPH patients were younger (P = 0.002 lumbar, P = 0.0001 cervical) and more were female (P = 0.039 lumbar, P = 0.045 cervical). Using multiple regression, a lumbar epidural contrast collection or cervical diverticulum extending beyond the lateral vertebral body correlated with PDPH (P < 0.0001 and P = 0.03, respectively).

Conclusions

PDPH correlates with a higher TDL score. Lumbar epidural contrast medium collections and cervical diverticula extending beyond the lateral vertebral body margin are associated with PDPH.

Key Points

• Elongated cervical nerve root sleeve diverticula are associated with post-dural puncture headaches.

• Lumbar epidural contrast medium collections are associated with post-dural puncture headaches.

• This information may help assess the risk of post-dural puncture headache.

Bezov D, Lipton RB, Ashina S (2010) Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache 50:1144–1152PubMedCrossRef

Tohmo H, Vuorinen E, Muuronen A (1998) Prolonged impairment in activities of daily living due to postdural puncture headache after diagnostic lumbar puncture. Anaesthesia 53:299–302PubMedCrossRef

Ghaleb A, Khorasani A, Mangar D (2012) Post-dural puncture headache. Int J Gen Med 5:45–51PubMedCentralPubMedCrossRef

Boonmak P, Boonmak S (2010) Epidural blood patching for preventing and treating post-dural puncture headache. Cochrane Database Syst Rev 1, CD001791PubMed

Lin W, Geiderman J (2002) Myth: fluids, bed rest, and caffeine are effective in preventing and treating patients with post-lumbar puncture headache. West J Med 176:69–70PubMedCentralPubMedCrossRef

Turnbull DK, Shepherd DB (2003) Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 91:718–729PubMedCrossRef

Wu CL, Rowlingson AJ, Cohen SR et al (2006) Gender and post-dural puncture headache. Anesthesiology 105:613–618PubMedCrossRef

Wadud R, Laiq N, Qureshi FA et al (2006) The frequency of postdural puncture headache in different age groups. J Coll Phys Surg Pak 16:389–392

Amorim JA, Valença MM (2008) Postdural puncture headache is a risk factor for new postdural puncture headache. Cephalalgia 28:5–8PubMed

10.

Rabin BM, Roychowdhury S, Meyer JR et al (1998) Spontaneous intracranial hypotension: spinal MR findings. AJNR Am J Neuroradiol 19:1034–1039PubMed

11.

Wendl CM, Schambach F, Zimmer C et al (2012) CT myelography for the planning and guidance of targeted epidural blood patches in patients with persistent spinal CSF leakage. AJNR Am J Neuroradiol 33:541–544PubMedCrossRef

12.

Awwad EE, Martin DS, Klein J (1995) Predictive value of postmyelographic computed tomography for patients with severe postmyelographic headache. South Med J 88:944–946PubMedCrossRef

13.

Headache Classification Subcommittee of the International Headache Society (2004) The international classification of headache disorders, 2nd edn. Cephalagia 24:9–160CrossRef

14.

Newcombe RG (1998) Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 17:857–872PubMedCrossRef

15.

Brown LD, Cai TT, DasGupta A (2001) Interval estimation for a binomial proportion. Stat Sci 16:101–117

16.

Fleiss JL (1971) Measuring nominal scale agreement among many raters. Psychol Bull 76:378–382CrossRef

17.

Landis JR, Koch GG (1997) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRef

18.

Linacre J (2008) The expected value of a point-biserial (or similar) correlation. Rasch Meas Trans 22:1154

19.

Marill KA (2004) Advanced statistics: linear regression, part II: multiple linear regression. Acad Emerg Med 11:94–102PubMedCrossRef

20.

Davenport EC, El-Sanhurry NA (1991) Phi/phimax: review and synthesis. Educ Psychol Meas 51:821–828CrossRef

21.

Stendell L, Fomsgaard JS, Olsen KS (2012) There is room for improvement in the prevention and treatment of headache after lumbar puncture. Dan Med J 59:A4483PubMed

22.

Lavi R, Rowe JM, Avivi I (2007) Traumatic vs. atraumatic 22 G needle for therapeutic and diagnostic lumbar puncture in the hematologic patient: a prospective clinical trial. Haematologica 92:1007–1008PubMedCrossRef

23.

Richman JM, Joe EM, Cohen SR et al (2006) Bevel direction and postdural puncture headache: a meta-analysis. Neurologist 12:224–228PubMedCrossRef

24.

Hammond ER, Wang Z, Bhulani N et al (2011) Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic. J Neurol Sci 306:24–28PubMedCrossRef

25.

Amorim JA, Gomes de Barros MV, Valença MM (2012) Post-dural (post-lumbar) puncture headache: risk factors and clinical features. Cephalalgia 32:916–923PubMedCrossRef

26.

Weir EC (2000) The sharp end of the dural puncture. Br Med J 320:127–128CrossRef

27.

Leibold RA, Yealy DM, Coppola M, Cantees KK (1993) Post-dural-puncture headache: characteristics, management and prevention. Ann Emerg Med 22:1863–1870PubMedCrossRef

Title: Incidental findings of CSF leakage in patients without spontaneous intracranial hypotension and development of post-dural puncture headache
Authors: Saeed Fakhran
Stacy Palfey
Andrew Thomas
Samuel Schwarz
Lea Alhilali
Publication date: 01-04-2014
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 4/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-013-3070-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Incidental findings of CSF leakage in patients without spontaneous intracranial hypotension and development of post-dural puncture headache

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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