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KMID : 0614520070170010046
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Journal of the Korean Pain Research Society
2007 Volume.17 No. 1 p.46 ~ p.50
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Recurred Postural Headache by Diagnostic Lumbar Puncture in Improved Spontaneous Intracranial Hypotensive Headache
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Park Hong-Lim
Lee Jae-Yong
Song Sun-Ok
Kim Heung-Dae
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Abstract
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Epidural blood patch (EBP) is one of the effective therapeutic modalities for spontaneous intracranial hypotension (SIH) complaining of postural headache, which is aggravated by the erect position and relieved by the supine position. The authors experienced a patient with SIH revealed a suspicious leakage of contrast media in the right C5∼6 level on CT myelogram. His postural headache was dramatically improved just following an EBP on C6∼7 interspace. However, 12 hours later, his headache was reappeared. We discussed lumbar puncture for CSF study or CT myelogram as a cause of recurred headache, and performed the second EBP on L4∼5. His symptom was continued with mild improvement except two-days relief after the procedure. We performed the third EBP on L3∼4 and his headache was dramatically improved without any residual symptoms. In this case, iatrogenic diagnostic lumbar puncture might be a cause of recurred headache following an effective EBP in SIH. To reduce the number of diagnostic puncture, we recommend simultaneously performing CSF study and CT myelogram or other radiological studies via a single lumbar puncture.
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KEYWORD
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Epidural blood patch, CT myelogram, Recurrence, Spontaneous intracranial hypotension
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