Top Tweets for #duralpuncture

2 months ago

🧠 PDPH: PUNCTURE, PERSISTENCE, or HEALING FAILURE? #PDPH #PostDuralPunctureHeadache #DuralPuncture #CSFLeak #EpiduralBloodPatch #HealingBiology #PatientSusceptibility #RegionalAnaesthesia #RegionalAnesthesia #GrayZonesInRA #GrayAreasInRA GRAY ZONES in RA: 🔸PDPH is familiar to every anesthesiologist. 🔸But it may not be only a puncture problem. 🔸It may also be a story of persistent CSF leak, delayed dural sealing, patient biology, diagnosis, and pathway-based care. 🟥 A. PUNCTURE STARTS THE STORY 🔸 Needle gauge matters 🔸 Needle tip design matters 🔸 Number of attempts matters 🔸 Accidental dural puncture matters 🔸 Operator experience matters 🔸 Technique remains important PDPH prevention begins with technique, but technique does not explain everything. 🟧 B. SAME PUNCTURE, DIFFERENT PATIENT 🔸 Some remain asymptomatic 🔸 Some develop mild headache 🔸 Some develop severe disability 🔸 Some recover quickly 🔸 Some have persistent symptoms 🔸 Some need EBP The puncture begins the syndrome, but patient response shapes the outcome. 🟨 C. PERSISTENCE DECIDES THE BURDEN 🔸 Dural rent may seal early 🔸 CSF leak may continue 🔸 Symptoms may persist 🔸 Disability may increase 🔸 Conservative treatment may fail 🔸 Escalation may be needed PDPH burden depends not only on the hole, but on why the hole remains open. 🟩 D. PATIENT BIOLOGY IS UNDEREXPLORED 🔸 Dural healing biology 🔸 Connective tissue characteristics 🔸 Headache phenotype 🔸 Pregnancy physiology 🔸 BMI 🔸 CSF pressure dynamics 🔸 Predictors of EBP failure 🔸 Risk of recurrence The patient may be as important as the puncture. 🟦 E. DIAGNOSIS NEEDS CAUTION 🔸 Orthostatic pattern matters 🔸 Timing matters 🔸 Severity matters 🔸 Associated symptoms matter 🔸 Differential diagnosis matters 🔸 Diagnostic anchoring should be avoided Diagnose PDPH early, but do not label every post-neuraxial headache as PDPH. 🟪 F. RED FLAGS MUST REOPEN THE DIAGNOSIS 🔸 Neurological deficit 🔸 Fever or meningism 🔸 Altered sensorium 🔸 Seizure 🔸 Severe hypertension 🔸 Non-postural headache 🔸 Worsening headache pattern 🔸 Poor response to usual care Red flags should never be hidden under the label of routine PDPH. 🟫 G. EBP REMAINS BEST ESTABLISHED 🔸 Uses autologous venous blood 🔸 Provides epidural tamponade 🔸 May seal the CSF leak 🔸 Often gives rapid relief 🔸 Timing matters 🔸 Repeat patch may be needed 🔸 Effective, but not perfect EBP is best-established, but not universally successful. ⬛ H. GOLD STANDARD DOES NOT MEAN PERFECT 🔸 Invasive procedure 🔸 Needs trained hands 🔸 Not universally practiced 🔸 May fail 🔸 Symptoms may recur 🔸 Long-term outcomes need clarity Gold standard means best-supported, not flawless. 🟥 I. ALTERNATIVES ARE BRIDGES, NOT EQUALS 🔸 Caffeine 🔸 Hydration 🔸 Analgesics 🔸 Sphenopalatine ganglion block 🔸 Greater occipital nerve block 🔸 Epidural saline 🔸 Cosyntropin 🔸 DISH10 maneuver Symptom relief is not always leak closure. 🟧 J. PATHWAY IS AS IMP AS PATCH 🔸 Early recognition 🔸 Patient counseling 🔸 Disability assessment 🔸 Red flag screening 🔸 Clear EBP criteria 🔸 Trained performer 🔸 Follow-up plan 🔸 Documentation and audit A gold-standard treatment needs a gold-standard pathway. 🎯 KEY TAKEAWAYS 🔹 The needle makes the hole 🔹 Patient biology decides the headache 🔹 Persistence decides the burden 🔹 Diagnosis needs caution 🔹 Red flags must be respected 🔹 EBP is best-established, not perfect 🔹 Alternatives are bridges, not equals 🔹 Pathway improves safety and consistency 🔥 PDPH PREVENTION begins with technique, PERSISTENCE may depend on biology, and TREATMENT needs evidence, training, and pathway. 🔥We have studied how the hole is made. Now we must study why the hole remains open.

KartikBSonawane's tweet photo. 🧠 PDPH: PUNCTURE, PERSISTENCE, or HEALING FAILURE?

#PDPH #PostDuralPunctureHeadache #DuralPuncture #CSFLeak #EpiduralBloodPatch #HealingBiology #PatientSusceptibility #RegionalAnaesthesia
#RegionalAnesthesia #GrayZonesInRA #GrayAreasInRA

GRAY ZONES in RA:

🔸PDPH is familiar to every anesthesiologist.
🔸But it may not be only a puncture problem.
🔸It may also be a story of persistent CSF leak, delayed dural sealing, patient biology, diagnosis, and pathway-based care.

🟥 A. PUNCTURE STARTS THE STORY
🔸 Needle gauge matters
🔸 Needle tip design matters
🔸 Number of attempts matters
🔸 Accidental dural puncture matters
🔸 Operator experience matters
🔸 Technique remains important
PDPH prevention begins with technique, but technique does not explain everything.

🟧 B. SAME PUNCTURE, DIFFERENT PATIENT
🔸 Some remain asymptomatic
🔸 Some develop mild headache
🔸 Some develop severe disability
🔸 Some recover quickly
🔸 Some have persistent symptoms
🔸 Some need EBP
The puncture begins the syndrome, but patient response shapes the outcome.

🟨 C. PERSISTENCE DECIDES THE BURDEN
🔸 Dural rent may seal early
🔸 CSF leak may continue
🔸 Symptoms may persist
🔸 Disability may increase
🔸 Conservative treatment may fail
🔸 Escalation may be needed
PDPH burden depends not only on the hole, but on why the hole remains open.

🟩 D. PATIENT BIOLOGY IS UNDEREXPLORED
🔸 Dural healing biology
🔸 Connective tissue characteristics
🔸 Headache phenotype
🔸 Pregnancy physiology
🔸 BMI
🔸 CSF pressure dynamics
🔸 Predictors of EBP failure
🔸 Risk of recurrence
The patient may be as important as the puncture.

🟦 E. DIAGNOSIS NEEDS CAUTION
🔸 Orthostatic pattern matters
🔸 Timing matters
🔸 Severity matters
🔸 Associated symptoms matter
🔸 Differential diagnosis matters
🔸 Diagnostic anchoring should be avoided
Diagnose PDPH early, but do not label every post-neuraxial headache as PDPH.

🟪 F. RED FLAGS MUST REOPEN THE DIAGNOSIS
🔸 Neurological deficit
🔸 Fever or meningism
🔸 Altered sensorium
🔸 Seizure
🔸 Severe hypertension
🔸 Non-postural headache
🔸 Worsening headache pattern
🔸 Poor response to usual care
Red flags should never be hidden under the label of routine PDPH.

🟫 G. EBP REMAINS BEST ESTABLISHED
🔸 Uses autologous venous blood
🔸 Provides epidural tamponade
🔸 May seal the CSF leak
🔸 Often gives rapid relief
🔸 Timing matters
🔸 Repeat patch may be needed
🔸 Effective, but not perfect
EBP is best-established, but not universally successful.

⬛ H. GOLD STANDARD DOES NOT MEAN PERFECT
🔸 Invasive procedure
🔸 Needs trained hands
🔸 Not universally practiced
🔸 May fail
🔸 Symptoms may recur
🔸 Long-term outcomes need clarity
Gold standard means best-supported, not flawless.

🟥 I. ALTERNATIVES ARE BRIDGES, NOT EQUALS
🔸 Caffeine
🔸 Hydration
🔸 Analgesics
🔸 Sphenopalatine ganglion block
🔸 Greater occipital nerve block
🔸 Epidural saline
🔸 Cosyntropin
🔸 DISH10 maneuver
Symptom relief is not always leak closure.

🟧 J. PATHWAY IS AS IMP AS PATCH
🔸 Early recognition
🔸 Patient counseling
🔸 Disability assessment
🔸 Red flag screening
🔸 Clear EBP criteria
🔸 Trained performer
🔸 Follow-up plan
🔸 Documentation and audit
A gold-standard treatment needs a gold-standard pathway.

🎯 KEY TAKEAWAYS
🔹 The needle makes the hole
🔹 Patient biology decides the headache
🔹 Persistence decides the burden
🔹 Diagnosis needs caution
🔹 Red flags must be respected
🔹 EBP is best-established, not perfect
🔹 Alternatives are bridges, not equals
🔹 Pathway improves safety and consistency
🔥 PDPH PREVENTION begins with technique, PERSISTENCE may depend on biology, and TREATMENT needs evidence, training, and pathway.
🔥We have studied how the hole is made.
Now we must study why the hole remains open.

569

Headache Journal @HeadacheJournal

about 3 years ago

Open Access: A causative role for remote #DuralPuncture and resultant arachnoid bleb in #NewDailyPersistentHeadache (#NDPH): A case report @AndrewCallenMD Peter Lennarson, @DrIanCarroll https://t.co/mQP37ztWcQ

HeadacheJournal's tweet photo. Open Access:
A causative role for remote #DuralPuncture and resultant arachnoid bleb in #NewDailyPersistentHeadache (#NDPH): A case report
@AndrewCallenMD Peter Lennarson, @DrIanCarroll
https://t.co/mQP37ztWcQ https://t.co/7HtKf9wYMJ

Headache Journal @HeadacheJournal

over 3 years ago

Management & outcomes of persistent #headache after accidental #DuralPuncture in the obstetric population: A 9-year prospective audit G. Niraj & Peter Critchley https://t.co/OgxfliPeDG

HeadacheJournal's tweet photo. Management & outcomes of persistent #headache after accidental #DuralPuncture in the obstetric population:
A 9-year prospective audit
G. Niraj & Peter Critchley

https://t.co/OgxfliPeDG https://t.co/cNmmCN2Ke6

🅚🅐🅨 💜💦 @Assidens

almost 5 years ago

New research shows - Long-Term Morbidity of Accidental Dural Puncture is Underappreciated. Additional & Devastating neurological symptoms hugely misunderstood and misdiagnosed in my experience. #csfleak #duralpuncture #postduralheadache https://t.co/t3ykiIo07s

Headache Journal @HeadacheJournal

almost 5 years ago

Did she have an #epidural? The long-term consequences of #postduralpuncture #headache & the role of unintended #duralpuncture @meredith_barad Ian Carroll MD, Miguel A Reina MD PhD, Jessica Ansari MD, Pamela Flood MD https://t.co/9B4zcBoCrz

HeadacheJournal's tweet photo. Did she have an #epidural? The long-term consequences of #postduralpuncture #headache & the role of unintended #duralpuncture
@meredith_barad Ian Carroll MD, Miguel A Reina MD PhD, Jessica Ansari MD, Pamela Flood MD
https://t.co/9B4zcBoCrz https://t.co/olZXv1JdP4

Becky Hill @BeckyHill3

about 5 years ago

@OBsleepmerchant This might interest you guys too: #arachnoidbleb following #duralpuncture #PDPH. She experienced both typical #spinalcsfleak & some #arachnoiditis symptoms for 3 yrs & #Epiduralbloodpatches would not hold long term.I have heard of a few of these which can only be fixed in surgery

International Journal of Obstetric Anesthesia @IJOA_Journal

over 6 years ago

Permanent hearing loss and tinnitus as a complication of accidental #duralpuncture, possibly due to altered cochlear physiology from CSF leak. https://t.co/tIFl9cPvQT @ELS_Anesthes @LoughreyJPR #OBAnes #IJOA #wettap

IJOA_Journal's tweet photo. Permanent hearing loss and tinnitus as a complication of accidental #duralpuncture, possibly due to altered cochlear physiology from CSF leak. https://t.co/tIFl9cPvQT @ELS_Anesthes @LoughreyJPR #OBAnes #IJOA #wettap https://t.co/AcIA9MS8DZ

Dr. Naveen Eipe, MD @NaveenEipe

over 7 years ago

@docmorne @VeenaGraffMD @nelkassabany @dr_rajgupta @lipidguy @KalagaraHari @CARLOSPINOMD @EMARIANOMD @amit_pawa @RobertGaiser1 @rosie_hogg #DuralPuncture with #Introducer DD- Dural Ectasia or fibrosis (?prev. SAB), Subarachinoid Cyst, Spinal Cord Abnormality (?Spina Bifida) etc. RT @Anaes_Journal Dural puncture with an introducer needle - Loader - 2008 - Anaesthesia - Wiley Online Library https://t.co/3r6LIR01vA

Terri Lewis, PhD #GratefulToBeVaccinated in TN-6 @tal7291

over 12 years ago

#AdhesiveArachnoiditis #Childbirthinjury #DuralPuncture This is what intractable pain looks like #NeedPalliativeCare

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