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Chapter 26. Postdural Puncture Headache
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In addition to headache, patients with postdural puncture headache (PDPH):
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B. May develop unilateral cranial nerve palsy
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C. Rarely experience associated symptoms
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D. Usually experience fever
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B is correct. In contrast to most bilateral and symmetric symptoms associated with PDPH, episodes of diplopia usually involve unilateral cranial nerve palsies.1
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A is incorrect. Most patients with PDPH experience nausea (the most common associated symptom).
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C is incorrect. The IHS criteria for PDPH require the presence of at least one associated symptom.
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D is incorrect. Fever is not associated with PDPH and should prompt investigation of other (eg, infectious) diagnoses.
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The risk of developing postdural puncture headache (PDPH) is decreased with:
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A. Cutting (eg, Quincke) needles
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D is correct. For reasons that are incompletely understood, older patients have a lower risk of PDPH than younger patients.2
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A is incorrect. The risk for PDPH is decreased with noncutting (eg, pencil-point) needles (Figure 26–1).
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B is incorrect. Nonpregnant female patients have approximately double the risk for PDPH compared with age-matched male patients.
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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.
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The meninges consist of the dura mater, arachnoid mater, and pia mater. Which of the following statements is true regarding the meninges?
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A. The dura mater contains frequent tight junctions.
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B. The arachnoid mater is acellular.
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C. The dura mater is thicker than the arachnoid mater.
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