postduralpunkti

Postdural puncture refers to a headache and related symptoms that occur after a dural puncture, most commonly during lumbar puncture or spinal anesthesia. The underlying cause is leakage of cerebrospinal fluid through the needle puncture, leading to intracranial hypotension and traction on pain-sensitive structures.

Clinical features typically begin within 24 to 72 hours after the puncture. The hallmark is an orthostatic headache: worse when standing or sitting and relieved by lying down. Additional symptoms can include neck stiffness, nausea, photophobia, tinnitus, dizziness, and mild cognitive difficulties. In uncommon cases, there may be subdural fluid collections or other complications; therefore new or worsening neurological symptoms require evaluation.

Diagnosis is mainly clinical, based on the temporal link to the dural puncture and the orthostatic nature of the pain. Imaging is not routinely required but can be helpful if the course is atypical or if there are red flags. Magnetic resonance imaging may show signs of intracranial hypotension, such as meningeal enhancement or sagging of the brain.

Management aims to relieve symptoms and, in persistent cases, to repair the CSF leak. Many cases resolve spontaneously within days to weeks. Conservative measures include analgesics (paracetamol or NSAIDs as appropriate), hydration, and, in some reports, caffeine or theophylline. Bed rest is not proven to hasten recovery. The most effective treatment for persistent or severe PDPH is an epidural blood patch, which often provides rapid and substantial relief. Alternative procedures include epidural saline patches or other neuraxial techniques in selected cases.

Prevention focuses on technique: using atraumatic, pencil-point needles when possible, minimizing the number of puncture attempts, and selecting appropriate needle size. Overall prognosis is good with proper management, though rare complications can occur.