Top Tweets for #epiduralbloodpatch
๐ง PDPH: PUNCTURE, PERSISTENCE, or HEALING FAILURE?
#PDPH #PostDuralPunctureHeadache #DuralPuncture #CSFLeak #EpiduralBloodPatch #HealingBiology #PatientSusceptibility #RegionalAnaesthesia
#RegionalAnesthesia #GrayZonesInRA #GrayAreasInRA
GRAY ZONES in RA:
๐ธPDPH is familiar to every anesthesiologist.
๐ธBut it may not be only a puncture problem.
๐ธIt may also be a story of persistent CSF leak, delayed dural sealing, patient biology, diagnosis, and pathway-based care.
๐ฅ A. PUNCTURE STARTS THE STORY
๐ธ Needle gauge matters
๐ธ Needle tip design matters
๐ธ Number of attempts matters
๐ธ Accidental dural puncture matters
๐ธ Operator experience matters
๐ธ Technique remains important
PDPH prevention begins with technique, but technique does not explain everything.
๐ง B. SAME PUNCTURE, DIFFERENT PATIENT
๐ธ Some remain asymptomatic
๐ธ Some develop mild headache
๐ธ Some develop severe disability
๐ธ Some recover quickly
๐ธ Some have persistent symptoms
๐ธ Some need EBP
The puncture begins the syndrome, but patient response shapes the outcome.
๐จ C. PERSISTENCE DECIDES THE BURDEN
๐ธ Dural rent may seal early
๐ธ CSF leak may continue
๐ธ Symptoms may persist
๐ธ Disability may increase
๐ธ Conservative treatment may fail
๐ธ Escalation may be needed
PDPH burden depends not only on the hole, but on why the hole remains open.
๐ฉ D. PATIENT BIOLOGY IS UNDEREXPLORED
๐ธ Dural healing biology
๐ธ Connective tissue characteristics
๐ธ Headache phenotype
๐ธ Pregnancy physiology
๐ธ BMI
๐ธ CSF pressure dynamics
๐ธ Predictors of EBP failure
๐ธ Risk of recurrence
The patient may be as important as the puncture.
๐ฆ E. DIAGNOSIS NEEDS CAUTION
๐ธ Orthostatic pattern matters
๐ธ Timing matters
๐ธ Severity matters
๐ธ Associated symptoms matter
๐ธ Differential diagnosis matters
๐ธ Diagnostic anchoring should be avoided
Diagnose PDPH early, but do not label every post-neuraxial headache as PDPH.
๐ช F. RED FLAGS MUST REOPEN THE DIAGNOSIS
๐ธ Neurological deficit
๐ธ Fever or meningism
๐ธ Altered sensorium
๐ธ Seizure
๐ธ Severe hypertension
๐ธ Non-postural headache
๐ธ Worsening headache pattern
๐ธ Poor response to usual care
Red flags should never be hidden under the label of routine PDPH.
๐ซ G. EBP REMAINS BEST ESTABLISHED
๐ธ Uses autologous venous blood
๐ธ Provides epidural tamponade
๐ธ May seal the CSF leak
๐ธ Often gives rapid relief
๐ธ Timing matters
๐ธ Repeat patch may be needed
๐ธ Effective, but not perfect
EBP is best-established, but not universally successful.
โฌ H. GOLD STANDARD DOES NOT MEAN PERFECT
๐ธ Invasive procedure
๐ธ Needs trained hands
๐ธ Not universally practiced
๐ธ May fail
๐ธ Symptoms may recur
๐ธ Long-term outcomes need clarity
Gold standard means best-supported, not flawless.
๐ฅ I. ALTERNATIVES ARE BRIDGES, NOT EQUALS
๐ธ Caffeine
๐ธ Hydration
๐ธ Analgesics
๐ธ Sphenopalatine ganglion block
๐ธ Greater occipital nerve block
๐ธ Epidural saline
๐ธ Cosyntropin
๐ธ DISH10 maneuver
Symptom relief is not always leak closure.
๐ง J. PATHWAY IS AS IMP AS PATCH
๐ธ Early recognition
๐ธ Patient counseling
๐ธ Disability assessment
๐ธ Red flag screening
๐ธ Clear EBP criteria
๐ธ Trained performer
๐ธ Follow-up plan
๐ธ Documentation and audit
A gold-standard treatment needs a gold-standard pathway.
๐ฏ KEY TAKEAWAYS
๐น The needle makes the hole
๐น Patient biology decides the headache
๐น Persistence decides the burden
๐น Diagnosis needs caution
๐น Red flags must be respected
๐น EBP is best-established, not perfect
๐น Alternatives are bridges, not equals
๐น Pathway improves safety and consistency
๐ฅ PDPH PREVENTION begins with technique, PERSISTENCE may depend on biology, and TREATMENT needs evidence, training, and pathway.
๐ฅWe have studied how the hole is made.
Now we must study why the hole remains open.
๐ฉธ ๐๐๐๐๐๐๐๐ ๐๐๐๐๐ ๐๐๐๐๐ (๐๐๐): ๐๐ซ๐๐๐ข๐ฌ๐ข๐จ๐ง ๐ข๐ง ๐๐๐ฎ๐ซ๐๐ฑ๐ข๐๐ฅ ๐๐จ๐ฆ๐ฉ๐ฅ๐ข๐๐๐ญ๐ข๐จ๐ง ๐๐๐ง๐๐ ๐๐ฆ๐๐ง๐ญ
#EpiduralBloodPatch #RegionalAnesthesia #NeuraxialAnesthesia #PDPH #PatientSafety #AnesthesiaEducation #PainMedicine #EpiduralSafety
#GrayZonesInRA #GrayAreasInRA
๐๐๐๐ ๐๐๐๐๐ ๐ข๐ง ๐๐:
1๏ธโฃ โ๏ธ ๐๐๐๐๐๐
๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐๐๐ ๐๐๐๐ ๐๐๐๐
๐น The EBP is far more than a simple treatment for PDPH.
๐น It is one of the most critical interventions in RA, requiring meticulous attention to:
โข Timing
โข Blood source
โข Patient selection
โข Contraindications
โข Procedural expertise
โข Complication prevention
๐น EBP acts as a highly effective biologic sealant that:
โข Restores CSF homeostasis
โข Seals dural defects
โข Rapidly reverses debilitating symptoms
๐น Anatomy + physiology + vascular safety + timing + judgment = outcome
2๏ธโฃ โ ๏ธ ๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐๐๐๐๐
๐ธ Optimal timing of intervention
๐ธ Appropriate blood volume selection
๐ธ Therapeutic vs prophylactic application
๐ธ Management in anticoagulated patients
๐ธ Infection and coagulopathy risks
๐ธ Repeat patch decisions
๐ธ Anatomical precision
๐ธ Strict vascular source safety
3๏ธโฃ ๐ ๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐ ๐๐
๐๐๐
๐ ๐๐ฆ๐ฆ๐๐๐ข๐๐ญ๐ ๐๐๐๐๐๐ญ (๐๐ซ๐๐ฌ๐ฌ๐ฎ๐ซ๐ ๐๐๐ฌ๐ญ๐จ๐ซ๐๐ญ๐ข๐จ๐ง)
๐น Raises epidural pressure
๐น Compresses thecal sac
๐น Restores CSF equilibrium
๐น Reduces meningeal traction
๐น Relieves orthostatic headache rapidly
๐ก๏ธ ๐๐๐๐ข๐ง๐ข๐ญ๐ข๐ฏ๐ ๐๐๐๐๐๐ญ (๐๐ข๐จ๐ฅ๐จ๐ ๐ข๐ ๐๐๐๐ฅ ๐
๐จ๐ซ๐ฆ๐๐ญ๐ข๐จ๐ง)
๐น Forms fibrin clot over dural rent
๐น Seals CSF leak
๐น Prevents ongoing fluid loss
๐น Promotes fibroblastic tissue healing
4๏ธโฃ ๐ฉธ ๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐
๐. ๐ต ๐๐๐๐๐๐ ๐๐๐๐๐ (๐๐๐๐ ๐๐๐๐๐๐๐๐)
๐ธ ๐๐๐ฆ๐จ๐๐ฒ๐ง๐๐ฆ๐ข๐ ๐๐๐ฏ๐๐ง๐ญ๐๐ ๐๐ฌ
๐น Low pressure
๐น Non-pulsatile flow
๐น Controlled epidural spread
๐น Predictable clot formation
๐ธ ๐๐ข๐จ๐ฅ๐จ๐ ๐ข๐๐๐ฅ ๐๐๐ฏ๐๐ง๐ญ๐๐ ๐๐ฌ
๐น Stable fibrin seal
๐น Physiologic clotting behavior
๐น Reduced endothelial trauma
๐น Lower embolic potential
๐ธ ๐๐ซ๐๐๐ญ๐ข๐๐๐ฅ ๐๐๐ฏ๐๐ง๐ญ๐๐ ๐๐ฌ
๐น Easily accessible
๐น Rapid bedside collection
๐น Safer procedural profile
๐.๐ด ๐๐๐๐๐๐๐๐ ๐๐๐๐๐ (๐๐๐๐๐๐๐)
๐ซ ๐๐๐ฆ๐จ๐๐ฒ๐ง๐๐ฆ๐ข๐ ๐๐๐ง๐ ๐๐ซ๐ฌ
๐บ High-pressure system
๐บ Pulsatile flow
๐บ Forceful epidural spread
๐บ Tissue dissection risk
๐บ Sudden spinal cord compression potential
โ ๏ธ ๐๐๐ฃ๐จ๐ซ ๐๐ข๐ฌ๐ค๐ฌ
๐ด Epidural hematoma
๐ด Cord ischemia
๐ด Vasospasm
๐ด Nerve root injury
๐ด Pseudoaneurysm
๐ด Neurological deficit
๐ด Paralysis
๐งฌ ๐๐ก๐ฒ ๐๐ซ๐ญ๐๐ซ๐ข๐๐ฅ ๐๐ฅ๐จ๐จ๐ ๐๐ฌ ๐๐๐ง๐ ๐๐ซ๐จ๐ฎ๐ฌ
๐บ Unpredictable clot dynamics
๐บ Greater pressure-related trauma
๐บ Increased vascular injury
๐บ Higher catastrophic complication potential
5๏ธโฃ ๐ ๐๐๐๐๐๐: ๐ ๐๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐๐ ๐๐
๐๐๐๐๐๐๐
๐๐๐ซ๐ฅ๐ฒ ๐๐๐ (<๐๐ ๐ก๐จ๐ฎ๐ซ๐ฌ)
๐น Faster relief in severe cases
๐ธ Higher failure rates
๐ธ Active CSF leakage may disrupt clot
๐๐๐ฅ๐๐ฒ๐๐ ๐๐๐ (๐๐โ๐๐ ๐ก๐จ๐ฎ๐ซ๐ฌ)
๐น Better clot stabilization
๐น Higher long-term efficacy
๐น Reduced repeat procedure need
6๏ธโฃ ๐ ๐๐๐ - ๐๐ง ๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐
๐๐๐ ๐ข๐ง๐ญ๐๐ ๐ซ๐๐ญ๐๐ฌ:
๐น Detailed neuraxial anatomy
๐น CSF physiology
๐น Hemodynamic principles
๐น Clot biology
๐น Infection prevention
๐น Procedural precision
๐น Risk-benefit judgment
๐ฏ ๐
๐๐๐๐ ๐๐๐๐๐๐๐๐๐ ๐
๐ฉธ Right Blood (Venous)
๐ Right Space (Epidural)
โฑ๏ธ Right Timing (Clinical Judgment)
๐ฅ EBP represents one of regional anesthesiaโs true ๐๐๐๐ ๐๐๐๐๐, where science, skill, & clinical judgment must align to safely transform ๐๐๐๐๐๐๐๐๐๐๐๐ ๐ข๐ง๐ญ๐จ ๐๐๐๐.
Epidural blood patches in persons w symptoms consistent w csf leak but not meeting criteria showed improvement in those w headaches that imprived on laying down. Paper link & podcast link in tweet below. #hEDS. #CSFLeak #EpiduralBloodPatch
@NeuroSjogrens Hi, I hope you don't mind me replying. I think you may find this paper from last year interesting - https://t.co/c5q8Ed0f5K
๐Podcast discussing that paper - https://t.co/EjokrmCPpr
๐ฆ Related session from the 2024 Bridging the Gap conference -
https://t.co/hshSvwRXVm
Dr. Ian Carroll gives 6๏ธโฃ causes of persistent CSF leak, despite properly done epidural blood patch โฌ๏ธ
#spinalCSFleak #EBP #EpiduralBloodPatch
Bridging the Gap Conference: Moderator Terri Baker, PA, introduces Dr. Ian Carroll and his talk on epidural blood patch basics.
When a Neurologist Gets a Cerebrospinal Fluid Leak https://t.co/Uebyd7jLJK via @JAMANeuro part of @JAMANetwork Great read describing the feelings and headache with #postduralpuncture headache and the amazingness of an #epiduralbloodpatch @PedsPainMed
Helping another Spinal CSF leak patient with ๐ฏ epidural blood patch. This is our 5th patient in our last few days! All due to type 1 ventral leak by the bony spicule and all are stable without recurrence #MedTwitter #neurotwitter #spinalcsfleak #headache #Epiduralbloodpatch
What is an #epiduralbloodpatch? What is the experience like? In this blog post, I share my experience with my first #bloodpatch to treat my #spinalcsfleak. #csfleak #SIH #spontaneousintracranialhypotension #invisibleillness
https://t.co/q8nv4fl77I
https://t.co/rGRyLsRz1Q
Exciting paper published on spinal CSF leaks/SIH using UK based data. Thank you to all involved for your dedication and your work on this.
#csfleak #spontaneousintracranialhypotension #epiduralbloodpatch #Myelography #posturalheadache #CSFleakassociation
Spread of blood from the lumbar to cervical epidural space with lumbar autologous #epiduralbloodpatch. E Ferrante, I Arpino, A Citterio, 2006 #CSFleaks https://t.co/DkszoQMk1f
New case on Instagram!
#EpiduralBloodPatch: What Happens Behind the Needle?
Submitted by Sylvain Redon, Jean-Franรงois Hak, @ArnaudJamon Anne Donnet
https://t.co/cmnixQEmpB
#InstagramThursdays
#HeadacheRFS
#MedTwitter
#MedEd
#HeadacheImages
#neurotwitter
#neurology
... it was my 3rd #EBP when I also realised how stiff and restricted my spine was when I was asked to curl my spine for the procedure. I also mention that 'buzzing legs & feet' is another common symptom for me. #epiduralbloodpatch #csfleak #arachnoiditis
Acute vision loss secondary to #epiduralbloodpatch
#Tersonsyndrome (Gabriel L. Pagani-Estรฉvez et al)
https://t.co/REtnZILI5e
#EpiduralBloodPatch
#AdhesiveArachnoiditis
Iga, K., Murakoshi, T., Kato, A. et al. Repeat epidural blood patch at the level of unintentional dural puncture and its neurologic complications: a case report. JA Clin Rep 5, 14 (2019). https://t.co/xPyxJqCPJ3
Grateful for this. Itโs as I suspected but helpful to b confirmed as โchronic neuro conditionsโ are on list. I think the main problem for those with leaks or post #epiduralbloodpatch will be a persistent cough. As coughing can make your #spinalcsfleak worse & give a leak/ re-leak
@HeadsUpNMC @KatyMunro1 I had a #occiptalnerveblock in Nov15 because they thought it might help my #lowpressureheadache (outdated thought by Anaesthetists). It did nothing as I was acute & couldnโt be upright more than 5mins. But a 2nd #epiduralbloodpatch helped a lot! #notamigraine #spinalcsfleak
Counting down the last day til i get an #EpiduralBloodPatch to treat the #CSFLeak that has dominated my life since mid August. Fingers crossed it works and this isn't yet another chronic thing. #NoHope #NoFear
Spotlight reveals Belfast Neurologist Dr Michael Watt carried out hundreds of dangerous and unnecessary procedures on patients. #bbcnewsni #spotlight #drwatt #michaelwatt #bloodpatch #epiduralbloodpatch #belfasttrust https://t.co/FqNfOUb7h0
Excellent refresher lecture on #PDPH and #epiduralbloodpatch by Dr Barbara Scavone in West, Room 2007 at #ANES18 #ObAnes @SOAPHQ
Another real and raw post about my current recovery from a 3 year #CSFleak #spinalcsfleak #epiduralbloodpatch no.4 #EBP #RHP https://t.co/Vc3tlfVCZn
@DrRanj @thismorning @DrZoeWilliams Good to see mention of epidural blood patching this morning https://t.co/WpNU2NRUdb #csfleak #uprightheadache #epiduralbloodpatch
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