Postdural puncture headache in complex regional pain syndrome: a retrospective observational study.
OBJECTIVE
To describe the unusual course of postdural puncture headache (PDPH) after pump implantation for intrathecal baclofen (ITB) administration in patients with complex regional pain syndrome (CRPS)-related dystonia.


METHODS
Case series based on data collected from 1996 to 2005. Setting. Movement disorders clinic, university hospital.


METHODS
A total of 54 patients with CRPS-related dystonia who were treated with ITB.


RESULTS
A high incidence (76%) and prolonged course (median 18 days, range 2 days to 36 months) of PDPH was found. Radionuclide studies performed in two patients with long-lasting symptoms (12-16 months) did not reveal cerebrospinal fluid (CSF) leakage. In patients without signs of CSF leakage (N = 38), epidural blood patches administered in 24 patients were effective in 54%, while ketamine infusions administered in six patients were effective in 67%.


CONCLUSIONS
Our observations may suggest that other mechanisms besides intracranial hypotension play a role in the initiation and maintenance of PDPH in CRPS and stimulate new directions of research on this topic.
Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
Alexander G
AG
Munts
Joan H C
JH
Voormolen
Johan
J
Marinus
Elmar M
EM
Delhaas
Jacobus J
JJ
van Hilten
D000293:Adolescent; D000328:Adult; D000778:Anesthetics, Dissociative / Q000008:administration & dosage; D001418:Baclofen / Q000008:administration & dosage / Q000009:adverse effects; D017217:Blood Patch, Epidural / Q000706:statistics & numerical data; D015984:Causality; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D020918:Complex Regional Pain Syndromes / Q000150:complications* / Q000503:physiopathology; D004388:Dura Mater / Q000293:injuries*; D004421:Dystonia / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D018755:GABA Agonists / Q000008:administration & dosage / Q000009:adverse effects; D006261:Headache / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007278:Injections, Spinal / Q000009:adverse effects; D019585:Intracranial Hypotension / Q000209:etiology / Q000503:physiopathology; D007649:Ketamine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult
D000778:Anesthetics, Dissociative; D018755:GABA Agonists; D007649:Ketamine; D001418:Baclofen