Spinal anaesthesia developed in the late 1800s with the work of Wynter, Quincke and Corning. However, it was the German surgeon, Karl August Bier in 1898, who probably gave the first spinal anaesthetic. Bier also gained first-hand experience of the disabling headache related to dural puncture. He correctly surmised that the headache was related to excessive loss of cerebrospinal fluid (CSF). In...

We describe a patient with an intracerebral haemorrhage following an accidental dural puncture during an attempted epidural for pain relief in labour. Anaesthetists need to include intracerebral haemorrhage in the differential diagnosis of post-dural puncture headache in the puerperium.

BACKGROUND Lumbar epidural blood patch (EBP) is a common treatment of post-dural puncture headache, but its effectiveness and mode of action remain a matter of debate. The aim of this study was to assess both the effectiveness and the predictive factors of failure of EBP on severe post-dural puncture headache. METHODS This prospective observational study includes all patients treated in the a...

BACKGROUND Inserting an intrathecal catheter after accidental dural puncture in parturients to prevent postdural puncture headache is becoming increasingly popular. We aimed to identify relevant published articles investigating this intervention and subject data to a meta-analysis. METHODS A systematic literature search was performed, paralleled by a hand search of abstract publications. Stud...

The incidence of epidural needle-induced post-dural puncture headache (PDPH) in parturients following dural puncture with a large bore (18-gauge) needle has been reported to range 76-85%. We describe seven cases in which the performance of epidural anesthesia in parturients was complicated by an unintentional dural puncture with an 18-gauge epidural needle. In all seven cases, the unintentional...

We report two unusual cases of postural, post-dural puncture upper thoracic interscapular backache, without headache, that were relieved by epidural blood patching. There is controversy concerning the aetiology of headache associated with the post-dural puncture syndrome. Mechanisms previously proposed have included traction on pain-sensitive intracranial structures such as the dura or blood ve...

Post-dural puncture headache is a common outcome following either spinal or epidural anesthesia. Cases were collected within five years' period (1988-1992) in Keelung Chang Gung Memorial Hospital. Those cases with relief of post-dural puncture headache after conservative treatment were excluded. There were 159 cases, 128 female patients and 31 male patients. Age ranged from 16-63 yrs. Post-dura...

PURPOSE To examine the hypothesis that lumbar puncture alone may cause meningeal enhancement in the brain. METHODS We prospectively reviewed the brain MR examinations of all patients from a 6-month period who were studied within 1 month after lumbar puncture. We also retrospectively reviewed all cases of dural-arachnoidal enhancement in the brain from the preceding 18-month period. RESULTS ...