Imaging Sciences (Radiology)

Epidural Blood Patch

Incidence of Spinal Headache

The chances of having a spinal headache depend on many factors including age, weight and size of needle used for the procedure. A spinal headache may occur up to 5 days after the lumbar puncture. This headache is often described as a headache like no other, being more severe when the patient is in the upright position and gets better when they are lying down.

Conservative Management

Conservative management includes adequate hydration to try to increase CSF pressure. Sometimes this is accomplished by IV hydration or drinking things high in caffeine, such as Mountain Dew soft drink, to produce a vasoconstriction and try to increase CSF pressure in this way. Another treatment may be strict bed rest for 24-48 hours.

Blood Patch

If conservative treatment fails, active treatment is required such as a blood patch. This is done by inserting an needle into the same space or a space just next to the space that was used for the lumbar puncture and injecting autologous blood. Relief from the spinal headache is often felt very quickly, and sometimes immediately after the blood patch is complete. Normal activities may be resumed shortly after the blood patch has had time to congeal. Very rarely does the blood patch not provide relief for the patient, but if it does not work the procedure may have to be repeated. Success rates for blood patches are 90% for the first blood patch, and 95% for the second blood patch.

Blood patches are performed for treatment of a persistent headache (spinal headache) and nausea that sometimes follows a spinal puncture. These symptoms do not occur frequently. The blood patch procedure consists of an injection at the spinal tap site of a small quantity of autologous blood. The introduction of this blood acts to patch the hole in the dura (the outer membrane of the spinal cord) that was created by the needle at the time of myelography.

Contraindications to performing a blood patch include septicemia, localized infection at the area of insertion, and active neurological disease.

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