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Post Dural Punchar Headache (PDPH)

 Post Dural Puncture Headache (PDPH) is typically occurs hours to day after puncture the spinal cord and present with the symptom like headache , nausea and vomiting also . The complication is commonly seen after spinal anesthesia . 

According to the International Classification of Headache Disorders criteria for the diagnosis of PDPH, headache develops within 5 days after dural puncture and disappears spontaneously within 1 week, or up to 48 h after an epidural blood patch .

 

Mechanism of Post Dural Punchar Headache

1  persistant leakage of CSF

2 Decrease CSF volume and pressure 

shift of intra cranial content                     activate adenosine resceptor

streaching the space                                   vasodialation of intra cranial vessel 

Pathophysiology

In 1899 , Augastin Biar was the first to describe about spinal anestheesia  and Post Dural Puncture Headache .

symptom 

nausea 

vomiting 

diplopia 

virtigo

tinnitus 

neck stiffness 

photophobia and e.t.c 

 
 
 
 Risk Factor 
 

PDPH is a common complication after inadvertent dural puncture. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and being a non-smoker. Needle size, design, and the technique used also affect the risk

Another risk factor for PDPH is vaginal delivery. Pushing efforts during the second stage can increase the size of the dural hole and CSF loss.

Prophylactic Interventions

several conservative therapies are commonly used, such as hydration and bed rest , while PDPH occurs . The aim of this method is to decrease the CSF loss through the hole . 

Treatment 

Take full bed rest for 48 hours 

Conservative 

fluid like RL , NS , DNS ETC

Aalgesia 

Drug

Epidural Therapy

prophylaxis

Dextran

Blood patch     
 

 

(All data are collected from various books and internet )

 

 

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