title: [Post-dural puncture headache and blood-patch: theoretical and practical approach].
abstract: OBJECTIVE
  To review the current research and formulate a rational approach to the physiopathology, cause and treatment of post-dural puncture headache (PDPH).
  
  
  METHODS
  Articles published to December 2011 were obtained through a search of Medline for the MeSh terms "epidural blood-patch" and "post-dural puncture headache".
  
  
  METHODS
  Six hundred and eighty-two pertinent studies were included and 200 were analysed.
  
  
  RESULTS
  Resulting of a dural tap after spinal anaesthesia or diagnostic lumbar puncture or as a complication of epidural anaesthesia, PDPH occurs when an excessive leak of cerebrospinal fluid leads to intracranial hypotension associated to a resultant cerebral vasodilatation. Reduction in cerebrospinal fluid volume in upright position may cause traction of the intracranial structure and stretching of vessels. Typically postural, headache may be associated to nausea, photophobia, tinnitus or arm pain and changes in hearing acuity. In severe cases, there may be cranial nerve dysfunction and nerve palsies secondary to traction on those nerves. The Epidural Blood-Patch (EBP) is considered as the "gold standard" in the treatment of PDHP because it induces a prolonged elevation of subarachnoid and epidural pressures, whereas such elevation is transient with saline or dextran. EBP should be performed within 24-48hours of onset of headache; the optimum volume of epidural blood appears to be 15-20mL. Severe complications following EBP are exceptional. The use of echography may be safety puncture. The optimum timing of epidural blood-patch, the resort of repeating procedure if the symptomatology does not disappear, the alternative to the conventional medical treatment need to be determined by future clinical trial.
authors.affiliation: Service d'anesthésie-réanimation, pôle URAD, hôpital Maison-Blanche, 45 rue Cognacq-Jay, Reims, France. aureilieff@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Fournet-Fayard
authors.forename: J-M
authors.initials: JM
authors.lastname: Malinovsky
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000009:adverse effects; D017217:Blood Patch, Epidural / Q000009:adverse effects / Q000379:methods; D002555:Cerebrospinal Fluid / Q000502:physiology; D002560:Cerebrovascular Circulation; D003389:Cranial Nerve Diseases / Q000209:etiology / Q000503:physiopathology; D003937:Diagnosis, Differential; D004824:Epidural Space; D006261:Headache / Q000175:diagnosis; D006319:Hearing Loss, Sensorineural / Q000209:etiology / Q000503:physiopathology; D046648:Hematoma, Subdural, Intracranial / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D019585:Intracranial Hypotension / Q000209:etiology / Q000503:physiopathology; D015201:Meta-Analysis as Topic; D059906:Neuroimaging; D051299:Post-Dural Puncture Headache / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D011187:Posture; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D014664:Vasodilation