OBJECTIVE: To look for any change in incidence and severity of post-LP-headache with or without intravenous(IV) hydration thirty-minutes before and after the procedure.BACKGROUND: Fronto-occipital dull headache, aggravated in the upright position, is a common, at times disabling, complication occurring within hours following Lumbar-puncture(LP). CSF leakage leading to reduction in CSF volume and pressure is the most accepted mechanism. Post-LP-headache is relieved when CSF volume and pressure returns to normal. Previous studies suggest that additional (mostly oral) hydration prevents the development of post-LP-headache, but the effectiveness and basic characteristics such as amount and time of hydration have not been established.DESIGN/METHODS: Patients 18-75 years old, with no prior history of headaches, elective diagnostic LP performed in supine position, using a Quincke-22-gauge needle, in our outpatient clinic in 2013 by one neurologist, were called on the telephone. Depending on whether the ordering physician requested IV hydration, patients did or did not receive 500 ml of normal saline 30 minutes before and after LP. Patients were asked about development of a post-LP-headache (with characteristics mentioned in the background), time of onset, severity (mild, moderate, severe), and treatment for relief. For analysis, patients were divided into two groups, group 1: with-hydration, and group 2: without-hydration.RESULTS: The study included 62 patients: group-1(n-30), and group-2(n-32). There was no difference between groups in age, sex, BMI, heart rate, blood pressure, or amount of CSF removed. Post-LP-headache: 33.3% in group 1 and 50.0% in group-2, but this difference did not reach statistical significance. Post-LP-headache severity: Group-1 (mild 78%, moderate 11%, severe 11%), Group-2 (mild 25%, moderate 6%, severe 69%) (p<.05).CONCLUSIONS: IV-hydration (500 ml, thirty-minute) before and after LP did not reduce the incidence of developing a post-LP-headache. However, IV-hydration reduced the severity of post-LP-headache significantly. Further studies with higher numbers of patients are needed to evaluate this pattern of results.STUDY SUPPORTED BY: None.
Disclosure: Dr. Gupta has nothing to disclose. Dr. Kowalska has nothing to disclose. Dr. Smith has nothing to disclose. Dr. Coyle has received personal compensation for activities with Acorda, Accordant, Bayer, Biogen Idec, Merck Serono/Pfizer, Genzyme/Sanofi Aventis, Mylan, Novartis, Genentech/Roche, and Teva Neuroscience. Dr. Coyle has received research support from Actelion, Novartis, and Opexa.
Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/P1.260?rss=1
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