Beyond Spinal Headache
ABSTRACT This Evidence-Based Case Management article evaluates and grades the evidence for two anesthesiology-related interventions: prophylaxis after unintentional meningeal puncture and treatment of spontaneous intracranial hypotension (SIH).
A search was made of relevant English language clinical studies or reports pertinent to the topic of low-pressure headache, but excluding the treatment of meningeal puncture headache.
Thirty-seven case reports, case series, and clinical trials were included to develop the best available evidence-based recommendations for the prophylaxis of unintentional meningeal puncture and for the treatment of SIH.
The highest quality randomized controlled trials suggest that prophylactic epidural blood patch (EBP) does not reduce the incidence of headache after unintentional meningeal puncture. The weight of existing literature supports EBP as an initial treatment of SIH, although its effectiveness does not approach that seen when EBP is used to treat meningeal puncture headache.
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ABSTRACT: Recent progress on developing diamond-based sensors for vertex detection at high luminosity hadron colliders is described. Measurements of the performance of diamond sensors after irradiation to fluences of up to 5×10<sup>15</sup> hadrons/cm<sup>2</sup> are shown. These indicate that diamond sensors will operate at distances as close as 5 cm from the interaction point at the Large Hadron Collider (LHC) for many years at full luminosity without significant degradation in performance. Measurements of the quality of the signals from diamond sensors as well as spatial uniformity are presented. Test beam results on measurements of diamond-based microstrip and pixels devices are describedIEEE Transactions on Nuclear Science 07/1999; DOI:10.1109/23.775513 · 1.46 Impact Factor
Article: Postdural Puncture Headache[Show abstract] [Hide abstract]
ABSTRACT: When headache after lumbar puncture is relieved by lying down, suspect PDPH.The American Journal of Nursing 10/1999; 99(11):48-49. · 1.32 Impact Factor
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ABSTRACT: The treatment of postdural puncture headache remains controversial, largely because it is insufficiently evidence based. With high rates of neuraxial block in the obstetric population likely to continue, postdural puncture headache will remain a primary cause of morbidity and increased duration of hospital stay. This review describes new reports of relevance published in 2006 and until October 2007. New evidence justifies epidural blood patch as the treatment of choice for severe postdural puncture headache, but technical aspects such as optimal timing and volume are less clear. Symptomatic medical management remains diverse, with a multitude of therapies often advocated, despite a lack of scientific support. Reports of misdiagnosis and of complications associated with postdural puncture headache and its treatment emphasize the importance of multidisciplinary management and additional investigation, including radiological imaging, when the clinical picture warrants. The key reports in this epoch have shed light on the benefits of careful assessment of postpartum headache and treatment with an epidural blood patch. New management paradigms have been suggested and serious complications continue to be reported.Current opinion in anaesthesiology 07/2008; 21(3):288-92. DOI:10.1097/ACO.0b013e3282f8e21a · 2.53 Impact Factor