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21.
Incidence of post-lumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients 总被引:1,自引:0,他引:1
The post-lumbar puncture syndrome (PLPS) can best be explained by prolonged spinal fluid leakage owing to delayed closure
of a dural defect. Its incidence after spinal anaesthesia is much lower than after diagnostic lumbar puncture (LP). This difference
could be caused by a strand of arachnoid, which might enter the needle with the outflowing cerebrospinal fluid (CSF) during
diagnostic LP and upon removal of the needle be threaded back through the dura to produce prolonged CSF leakage. To find a
technique that further reduces the incidence of PLPS, this hypothesis was tested by evaluating the effect that reinserting
the stylet before removing the needle had on the incidence of PLPS. By reinserting the stylet to the tip of the needle, the
hypothesized strand would be pushed out, thereby reducing the frequency of PLPS. Sprotte’s “atraumatic needle” (21 gauge)
was used for LP. A total of 600 patients participated in the prospective study. They were randomized into two groups and questioned
about their complaints every day for up to 7 days after the LP. All LPs were performed by two experienced neurologists (T.B.,
M.S.). In 300 patients, the stylet was reinserted to the tip of the needle; in the other 300 it was not reinserted. Whereas
49 of the 300 patients without reinsertion developed PLPS, only 15 of the 300 patients with reinsertion did. This significant
difference (16.3 vs 5.0%, P < 0.005, chi square test) supports our hypothesis. On the basis of our results, we recommend reinserting the stylet before
removing the needle in order to reduce the incidence of PLPS.
Received: 30 September 1997 Received in revised form: 9 March 1998 Accepted: 20 March 1998 相似文献
22.
Peter Schnider MD Joachim Maly PhD Josef Grünberger PhD Susanne Aull MD Karl Zeiler MD Peter Wessely MD 《Headache》1995,35(5):269-272
A considerable proportion of headache patients fulfill the criteria of "drug abuse" (definition according to the International Headache Society [IHS] criteria). These patients exhibit markedly reduced vigilance and continuous performance, as shown by the results of critical flicker frequency (CFF) analysis.
The present study deals with the question whether this impairment of vigilance and continuous performance is reversible. Forty-eight headache patients with drug abuse were investigated three times by means of CFF analysis: immediately before (A), immediately after (B), and 3 weeks after having finished (C) inpatient drug withdrawal.
Immediately after withdrawal, a significant decrease of headache intensity was observed. The CFF values, however, remained unchanged at a depressed level, probably due to withdrawal medication and the initial sedative side effects of thymoleptic agents (given as prophylaxis).
Three weeks after withdrawal, however, the CFF values were significantly improved, and were now within a range not far from the normal values known from a healthy general population. Thus, even after many years of drug abuse, headache patients have a good chance to improve their vigilance and continuous performance and to reach normal or close to normal levels. 相似文献
The present study deals with the question whether this impairment of vigilance and continuous performance is reversible. Forty-eight headache patients with drug abuse were investigated three times by means of CFF analysis: immediately before (A), immediately after (B), and 3 weeks after having finished (C) inpatient drug withdrawal.
Immediately after withdrawal, a significant decrease of headache intensity was observed. The CFF values, however, remained unchanged at a depressed level, probably due to withdrawal medication and the initial sedative side effects of thymoleptic agents (given as prophylaxis).
Three weeks after withdrawal, however, the CFF values were significantly improved, and were now within a range not far from the normal values known from a healthy general population. Thus, even after many years of drug abuse, headache patients have a good chance to improve their vigilance and continuous performance and to reach normal or close to normal levels. 相似文献
23.
24.
Abstract: Spontaneous intracranial hypotension (SIH) is a postural headache syndrome unrelated to dural puncture. Because of the increasing failure of epidural blood patch (EBP) to relieve headache in SIH, we retrospectively investigated the epidemiological features and treatment outcomes in 55 cases of SIH. The study population was stratified by age and sex; continuous variables were compared for differences by t -tests; categorical variables were compared by Chi-squared analysis or Fisher exact tests. Significant differences were identified by P values of 0.05 or less. The mean age of the study population was 44 ± 12 years with a female to male ratio of 1.3:1.0. Men presented with subdural hematomas ( P = 0.001) more often than women. Meningeal enhancement on contrast magnetic resonance imaging (MRI) was the most consistent radiographic finding. Radionuclide cisternography (RC) demonstrated thoracolumbar dural leaks in 16 of 22 patients. EBP failures were more common in patients aged 40 and younger than in older patients ( P = 0.003). Postural headache from SIH was not uniformly responsive to EBP, and had significant comorbidities, especially in men. The management of postural headache in SIH by other techniques to restore brain position and cerebrospinal fluid dynamics should be investigated. 相似文献
25.
王翠欣 《现代电生理学杂志》2006,13(1):17-19
目的:探讨头痛、头痛型癫与脑电图(EEG)的相关性。方法:对22例发作性头痛的患儿,在头痛间期进行了常规EEG及动态脑电图(AEEG)检查,并对其临床与EEG改变进行了相关分析。结果:单纯发作性头痛而无癫发作或癫家族史,若EEG有典型癫样放电、抗癫治疗效果显著,可以诊断为头痛型癫;单纯发作性头痛而无癫发作或癫家族史,尽管EEG有典型癫样放电,但一般药物治疗有效,应诊断为偏头痛或血管性头痛更为合适。结论:EEG检查可为头痛与头痛型癫的筛选、诊断、治疗、转归及预后提供客观依据。 相似文献
26.
L. J. Stovner J.-A. Zwart K. Hagen G. M. Terwindt J. Pascual 《European journal of neurology》2006,13(4):333-345
The present review of epidemiologic studies on migraine and headache in Europe is part of a larger initiative by the European Brain Council to estimate the costs incurred because of brain disorders. Summarizing the data on 1-year prevalence, the proportion of adults in Europe reporting headache was 51%, migraine 14%, and 'chronic headache' (i.e. > or =15 days/month or 'daily') 4%. Generally, migraine, and to a lesser degree headache, are most prevalent during the most productive years of adulthood, from age 20 to 50 years. Several European studies document the negative influence of headache disorders on the quality of life, and health-economic studies indicate that 15% of adults were absent from work during the last year because of headache. Very few studies have been performed in Eastern Europe, and there are also surprisingly little data on tension-type headache from any country. Although the methodology and the quality of the published studies vary considerably, making direct comparisons between different countries difficult, the present review clearly demonstrates that headache disorders are extremely prevalent and have a vast impact on public health. The data collected should be used as arguments to increase resources to headache research and care for headache patients all over the continent. 相似文献
27.
Four patients, who received epidural blood patch to treat postdural puncture headache, were examined with computed tomography in order to demonstrate the distribution of the injected blood. Blood alone could not be identified, but adding 2 ml contrast agent Iohexol 180 mg J/ ml (Omnipaque®, Nycomed Imaging) to 18 ml blood gave an excellent demonstration of the distribution of the blood in the epidural space, both cranio-caudally (7–14 segments) and spatially in relation to the epidural septae. The blood-contrast media had a strong affinity to the dural sac. There was no support of the spacefilling effect of blood patch. 相似文献
28.
用放射免疫分析法测定了28例偏头痛、10例慢性紧张型头痛患者和16例健康对照组血浆精氨酸加压素(AVP)、催产素(OT)、环磷酸腺苷(cAMP)及环磷酸鸟苷(cGMP)含量。结果表明,偏头痛发作期AVP含量下降、cAMP含量升高,偏头痛间歇期cGMP含量下降,血浆OT含量在发作期和间歇期均明显下降。慢性紧张型头痛患者血浆AVP、OT、cAMP和cGMP与对照组比较均无显著性差异。结果提示,血浆AVP和OT水平降低以及环核苷酸的代谢异常与偏头痛发病机制有关。 相似文献
29.
Lars Bendtsen Rigmor Jensen Jannick Brennum Lars Arendt-Nielsen Jes Olesen 《Cephalalgia : an international journal of headache》1993,13(3):184-191
The duration of the late exteroceptive suppression period (ES2 ) of temporal muscle EMG activity has been reported to be reduced in patients suffering from chronic tension-type headache. Methods of recording and analysing ES2 have varied between centers and reproducibility of results within subjects , although insufficiently studied, has generally been poor. ES2 was investigated in 30 healthy subjects, using a computerized technique of recording, rectifying and averaging the EMG signals. Hour to hour and week to week variations of ES2 durations were calculated, and the influence of pain during a cold pressor test and of sustained muscle contraction on ES2 durations was investigated. The intra-individual variation of ES2 durations was 16.0% from hour to hour and 20.7% from week to week. The inter-individual variation was 36.7%. The present method for analysis of ES2 periods proved to be reliable, as the intra-observer variation was 4.2% and the inter-observer variation 4.6%. ES2 periods were significantly shorter on the first compared to the second day of examination ( p = 0.006) and during experimental pain ( p = 0.0005). We recommend the use of the computerized averaging technique in future studies and caution against the dependence of results upon factors such as conditioning and pain. 相似文献
30.
《Headache》1993,33(2):98-104
SYNOPSIS
Respiratory sinus arrhythmia is regarded as indicative of cardiac vagal integrity. A ratio of the longest R-R interval to the shortest R-R interval during deep breathing test (E:I ratio) was calculated in controls (n=49), cluster headache (n=33) and CPH (n=4) patients, E:I ratio decreased with age but was not dependent upon sex or upon smoking habits. Furthermore, there were no significant differences as regards E:I ratio between cluster headache patients in and outside a bout, or between patients with right-sided and left-sided headache. However, the E:I ratio was found to be significantly lower in the cluster headache group as such, when compared with controls, but the number of patients disclosing pathological or borderline results was small, 2 and 2, respectively. This may indicate that a putative vagal dysfunction in cluster headache is usually less marked than in patients with e.g. diabetic autonomic neuropathy. Significant attack-related change in the E:I ratio were detected in all individual patients though these changes were not of a uniform nature from individual to individual. E:I ratios were rather high in 3 out of 4 CPH patients examined. However, the number of patients in this group is too small to allow definite statements about the difference between CPH end cluster headache with regard to E:I ratios. There was no significant difference between E:I ratios outside and during a mild, short, mechanically precipitated attack in a single CPH patient. 相似文献
Respiratory sinus arrhythmia is regarded as indicative of cardiac vagal integrity. A ratio of the longest R-R interval to the shortest R-R interval during deep breathing test (E:I ratio) was calculated in controls (n=49), cluster headache (n=33) and CPH (n=4) patients, E:I ratio decreased with age but was not dependent upon sex or upon smoking habits. Furthermore, there were no significant differences as regards E:I ratio between cluster headache patients in and outside a bout, or between patients with right-sided and left-sided headache. However, the E:I ratio was found to be significantly lower in the cluster headache group as such, when compared with controls, but the number of patients disclosing pathological or borderline results was small, 2 and 2, respectively. This may indicate that a putative vagal dysfunction in cluster headache is usually less marked than in patients with e.g. diabetic autonomic neuropathy. Significant attack-related change in the E:I ratio were detected in all individual patients though these changes were not of a uniform nature from individual to individual. E:I ratios were rather high in 3 out of 4 CPH patients examined. However, the number of patients in this group is too small to allow definite statements about the difference between CPH end cluster headache with regard to E:I ratios. There was no significant difference between E:I ratios outside and during a mild, short, mechanically precipitated attack in a single CPH patient. 相似文献