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Chapter 26. Postdural Puncture Headache

In addition to headache, patients with postdural puncture headache (PDPH):

A. Are seldom nauseated

B. May develop unilateral cranial nerve palsy

C. Rarely experience associated symptoms

D. Usually experience fever

B is correct. In contrast to most bilateral and symmetric symptoms associated with PDPH, episodes of diplopia usually involve unilateral cranial nerve palsies.1

A is incorrect. Most patients with PDPH experience nausea (the most common associated symptom).

C is incorrect. The IHS criteria for PDPH require the presence of at least one associated symptom.

D is incorrect. Fever is not associated with PDPH and should prompt investigation of other (eg, infectious) diagnoses.

The risk of developing postdural puncture headache (PDPH) is decreased with:

A. Cutting (eg, Quincke) needles

B. Female gender

C. Large-gauge needles

D. Older age

D is correct. For reasons that are incompletely understood, older patients have a lower risk of PDPH than younger patients.2

A is incorrect. The risk for PDPH is decreased with noncutting (eg, pencil-point) needles (Figure 26–1).

B is incorrect. Nonpregnant female patients have approximately double the risk for PDPH compared with age-matched male patients.

C is incorrect. Needle gauge is a major risk factor for PDPH, with meningeal puncture with large-gauge needles being associated with a greater chance of developing PDPH, more severe symptoms, and higher likelihood of needing an epidural blood patch.

Figure 26–1

Spinal needles of different manufacturers with same external diameter. Non-cutting: A: Whitacre type. B: Spinal type. C: Sprotte type. Cutting: D and E: Quincke type. Scanning electron microscopy. Magnification X40.

(Reproduced with permission from van Kooten F, Oedit R, Bakker SL, et al: Epidural blood patch in post dural puncture headache: a randomised, observer-blind, controlled clinical trial, Neurol Neurosurg Psychiatry. 2008 May;79(5):553-558.)

The meninges consist of the dura mater, arachnoid mater, and pia mater. Which of the following statements is true regarding the meninges?

A. The dura mater contains frequent tight junctions.

B. The arachnoid mater is acellular.

C. The dura mater is thicker than the arachnoid mater.

D. The alignment of dural ...

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