関: post-lumbar puncture headache、postdural puncture headache

WordNet

ride Western style and bob up and down in the saddle in rhythm with a horses trotting gait
an upright consisting of a piece of timber or metal fixed firmly in an upright position; "he set a row of posts in the ground and strung barbwire between them"
the delivery and collection of letters and packages; "it came by the first post"; "if you hurry youll catch the post"
a pole or stake set up to mark something (as the start or end of a race track); "a pair of posts marked the goal"; "the corner of the lot was indicated by a stake" (同)stake
the position where someone (as a guard or sentry) stands or is assigned to stand; "a soldier manned the entrance post"; "a sentry station" (同)station
mark or expose as infamous; "She was branded a loose woman" (同)brand
transfer (entries) from one account book to another (同)carry
place so as to be noticed; "post a sign"; "post a warning at the dump" (同)put_up
affix in a public place or for public notice; "post a warning"
assign to a post; put into a post; "The newspaper posted him in Timbuktu"
display, as of records in sports games
enter on a public list
publicize with, or as if with, a poster; "Ill post the news on the bulletin board"
pierce with a pointed object; make a hole into; "puncture a tire"
be pierced or punctured; "The tire punctured"
cause to lose air pressure or collapse by piercing; "puncture an air balloon"
a small hole made by a sharp object
the act of puncturing or perforating
loss of air pressure in a tire when a hole is made by some sharp object
make by piercing; "puncture a hole"
United States manufacturer of breakfast cereals and Postum (1854-1914) (同)C. W. Post, Charles William Post
United States female author who wrote a book and a syndicated newspaper column on etiquette (1872-1960) (同)Emily Post, Emily Price Post
United States aviator who in 1933 made the first solo flight around the world (1899-1935) (同)Wiley Post
pain in the head caused by dilation of cerebral arteries or muscle contractions or a reaction to drugs (同)head ache, cephalalgia
(bookkeeping) a listing on the companys records; "the posting was made in the cash account"

PrepTutorEJDIC

〈C〉(木・金属・石などの)『柱』,『支柱』,くい / 《the ~》(競馬の)出発標,決勝標 / 〈C〉《話》(ラグビーなどの)ゴールポスト(goalpost) / (柱・壁などに)〈掲示物〉‘を'『張る』,張り出す《+『名』〈掲示物〉+『on』+『名』》;(掲示物を)〈柱・壁など〉‘に'張る《+『名』+『with』+『名』〈掲示物〉》 / (掲示して)…‘を'公表する,公示する / 《通例受動態で》(…として)…‘を'掲示(発表)する《+『名』+『as』+『現分』(過分)》
(兵士・警官・看護婦などの)『部署』,『持ち場』 / (軍隊の)駐屯(ちゅうとん)地,駐留地,兵営地 / (指名・任命された)『地位』,職 / (またtrading post)(未開地などの)交易所 / 〈兵士・警官・看護婦など〉‘を'配置する / 《通例受動態で》《おもに英》(…に)〈人〉‘を'任命する《+『名』+『to』+『名』》
〈U〉《おもに英》『郵便』[制度] / 《おもに英》《単数形で》(郵便物の1回の)『集配』,『配達』,便;(1回で集配・配達される)郵便物(《米》mail) / 《the ~》《おもに英》郵便局(post office);ポスト,郵便箱(《米》mailbox) / 〈C〉(昔,郵便物の中断所にした)駅,宿,宿場 / 《おもに英》〈郵便物〉‘を'郵便局に出す,ポストに入れる(《米》mail)《+『off』+『名』+『,』『名』+『off』》 / 《『post』+『名』〈間〉〈人〉+『名』〈直〉=『post』+『名』+『to』+『名』〈人〉》〈人〉‘に'〈手紙など〉‘を'郵便で送る(《米》mail)
(とがったもので)…‘に'穴をあける,‘を'パンクさせる《+『名』+『with』+『名』》 / 〈穴など〉‘を'あける / …‘を'パチンと壊す / (とがったものでできた)穴 / (とがったもので)穴をあけること;(タイヤの)パンク
『頭痛』 / 《話》悩みの種
《おもに英》(特に軍職に)任命すること

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/02 21:11:54」(JST)

wiki en

Post-dural-puncture headache (PDPH) is a complication of puncture of the dura mater (one of the membranes that surround the brain and spinal cord).^[1] It is a common side-effect of spinal anesthesia and lumbar puncture and may occasionally accidentally occur in epidural anesthesia. Leakage of cerebrospinal fluid through the dura mater puncture causes reduced fluid levels in the brain and spinal cord, and may lead to the development of PDPH hours or days later. Onset occurs within two days in 66 percent and within three days in ninety percent of PDPH cases. It occurs so rarely immediately after puncture that other possible causes should be investigated when it does.^[2]

The headache is severe and described as "searing and spreading like hot metal," involving the back and front of the head, and spreading to the neck and shoulders, sometimes involving neck stiffness. It is exacerbated by movement, and sitting or standing, and relieved to some degree by lying down. Nausea, vomiting, pain in arms and legs, hearing loss, tinnitus, vertigo, dizziness and paraesthesia of the scalp are common.^[2]

Presentation and pathophysiology

PDPH typically occurs hours to days after puncture and presents with symptoms such as headache (which is mostly bi-frontal or occipital) and nausea that typically worsen when the patient assumes an upright posture.

It is thought to result from a loss of cerebrospinal fluid^[1] into the epidural space. A decreased hydrostatic pressure in the subarachnoid space then leads to traction to the meninges with associated symptoms.

The incidence of PDPH is higher with younger patients, complicated or repeated puncture, and use of large diameter needles, in females, in pregnancy, and with darker skin. Modern, atraumatic needles such as the Sprotte or Whitacre spinal needle leave a smaller perforation and reduce the risk for PDPH.

Treatment

Some patients require no other treatment than analgesics, and bed rest. A 2007 review of the current evidence by Mayo Clinic researchers found "The wide endorsement for caffeine to prevent and treat PDPH found in textbooks and review articles appears to be unwarranted and insufficiently supported by the available pharmacological and clinical evidence."^[3]

Persistent and severe PDPH may require an epidural blood patch. A small amount of the patient's blood is injected into the epidural space near the site of the original puncture; the resulting blood clot then "patches" the meningeal leak. The procedure carries the typical risks of any epidural puncture. However, it is effective,^[4] and further intervention is rarely necessary.

Prevention

The conventional medical wisdom over the last several decades for avoiding PDPH has been to use smaller gauge or modern needles which traumatize the dura less or make a smaller dura puncture, thereby lessening CSF leakage that causes PDPH. While these approaches have been effective at lowering PDPH rates, they have been unsuccessful at completely preventing PDPH. There is evidence that a more effective preventative approach is to make a self-closing puncture in the dura, using a simple beveled needle with a specific angle and bevel orientation. ^[5] ^[6] This approach can also prevent PDPH headaches caused by over-penetration during epidural anesthesia (where dural puncture was never intended), since withdrawal of the needle allows the dural puncture to self-close.

The use of a 3-bevel (Quinke) needles is highly associated with PDPH as the geometry of the needle can create a "flap" that allows CSF leakage when inserted in standard horizontal position (open face of needle cephalad). Inserting the needle vertically (open face directed left or right) splits the dural fibers and reduced the flap size. However older clinicians advocate completely inverting the needle and inserting horizontally but upside down so the open face of the Quinke is directed caudad. This also creates a flap but the geometry is inverted so that the flap is on the inside of the dura and is forced closed by hydrostatic pressure. The incidence of PDPD using a Quinke needle in standard orientation is approximately 3%-7%, Approximately 1.5%-3% when inserted vertically; Approximately 0.1% when inserted inverted.^{[citation needed]}

References

^ ^a ^b Turnbull DK, Shepherd DB (November 2003). "Post-dural puncture headache: pathogenesis, prevention and treatment". Br J Anaesth 91 (5): 718–29. doi:10.1093/bja/aeg231. PMID 14570796.
^ ^a ^b Turnbull GK & Shepherd DB (2003). "Post‐dural puncture headache: pathogenesis, prevention and treatment". British Journal of Anaesthesia 81 (5): 718–729. doi:10.1093/bja/aeg231. PMID 14570796.
^ Halker RB, Demaerschalk BM, Wellik KE et al. (September 2007). "Caffeine for the prevention and treatment of postdural puncture headache: debunking the myth". Neurologist 13 (5): 323–7. doi:10.1097/NRL.0b013e318145480f. PMID 17848873.
^ Safa-Tisseront V, Thormann F, Malassiné P et al. (August 2001). "Effectiveness of epidural blood patch in the management of post-dural puncture headache". Anesthesiology 95 (2): 334–9. doi:10.1097/00000542-200108000-00012. PMID 11506102.
^ Bela I. Hatfalvi, M.D. (1977). "The dynamics of post-spinal headache". Headache 17: 64–66.
^ Bela I. Hatfalvi, M.D. (July–August 1995). "Postulated Mechanisms for Post Dural Puncture Headache: Clinical Experience and Review Of Laboratory Models". Regional Anesthesia 20 (4): 329–336.

UpToDate Contents

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1. 腰椎穿刺後頭痛 post lumbar puncture headache
2. Spinal anesthesia: Technique
3. 産婦人科における硬膜外・脊椎麻酔の副作用 adverse effects of neuraxial analgesia and anesthesia for obstetrics
4. 腰椎穿刺：成人における手技、適応、禁忌、および合併症 lumbar puncture technique indications contraindications and complications in adults
5. 腰椎穿刺：小児における適応、禁忌、手技、および合併症 lumbar puncture indications contraindications technique and complications in children

English Journal

Major complications of epidural anesthesia: a prospective study of 5083 cases at a single hospital.

Kang XH1, Bao FP, Xiong XX, Li M, Jin TT, Shao J, Zhu SM.
Acta anaesthesiologica Scandinavica.Acta Anaesthesiol Scand.2014 Aug;58(7):858-66. doi: 10.1111/aas.12360. Epub 2014 Jun 24.
BACKGROUND: We undertook a prospective study of non-obstetric epidurals placed in surgical inpatients at a single teaching hospital to evaluate the incidence of and potential risk factors for major complications of continuous epidural anesthesia.METHODS: Demographic information, details of the epidu
PMID 24961586

Subdural hygroma accompanied by parenchymal and subarachnoid haemorrhage after epidural analgesia in an obstetric patient.

Del-Rio-Vellosillo M1, Garcia-Medina JJ, Fernandez-Rodriguez LE, Martin-Gil-Parra R, Lopez-Perez J, Almagro-Navarro MJ.
Acta anaesthesiologica Scandinavica.Acta Anaesthesiol Scand.2014 Aug;58(7):897-902. doi: 10.1111/aas.12308. Epub 2014 Mar 14.
BACKGROUND: Anaesthetists need to know the different causes of persistent headache or a change in level of consciousness following epidural analgesia for labour. Failure to recognise these neurological complications can lead to delayed diagnoses, with subsequent serious implications.METHODS: We pres
PMID 24628098

[Unknown intracerebral tumour presenting as brainstem compression following unintentional dural puncture].

Castro-Castro J1, Figueiredo-González O2, Río-Gómez A2, Carballo-Loureiro N2, Castro-Bouzas D3.
Revista española de anestesiología y reanimación.Rev Esp Anestesiol Reanim.2014 Aug-Sep;61(7):392-5. doi: 10.1016/j.redar.2013.06.012. Epub 2013 Sep 14.
A 36-year old primigravid of 41 weeks gestation was admitted to the labour ward. Her past medical history included hyperemesis gravidarum and migraine. An accidental dural puncture occurred during labour epidural analgesia. In the postpartum period she presented with continuous headache, and was tre
PMID 24041454