La rachicentesi diagnostica: Indagine interna all'istituto Neurologico C. Besta e revisione sistematica della letteratura sulla cefalea post-rachicentesi

Translated title of the contribution: Diagnostic lumbar puncture: Study on the headache post-punction and systematic review of the literature

Andrea Salmaggi, Moreschi Clara, Saba Motta, Graziella Filippini

Research output: Contribution to journalArticle

Abstract

Diagnostic lumbar puncture is a frequently utilized procedure in Neurological Units; despite the availability of some evidence concerning the prevention of its most frequent side effect (i.e., headache), the clinical practice during and after LP is still highly variable. A multi disciplinary working team composed of neurologists, professional nurses and a librarian with expertise in medical literature search started a prospective study in 3 Neurological Units at National Neurological Institute C. Besta, together with a systematic literature search about factors predisposing to post-LP headache and about indication to post-LP bed rest. Within the prospective study, 2 specifically designed questionnaires were filled by the nurse and by the patient, allowing collection of the following data: modalities of LP (patient decubitus, needle type and diameter, needle orientation in respect to dural fibers, volume of CSF withdrawn, reinsertion of the needle in the stylet before extraction, number of trials for LP), duration of limitations in movement advised after LP, occurrence of headache with features of post-LP headache. Within 4 months, 102 patients have been included in the study (52 male, 50 female, median age 50, range 219-78). All patients underwent LP by standard Quincke needles, mostly with 20 Gauge-diameter. 39% developed post-LP headache. Factors predictive for the subsequent development of headache included: female sex (p=0.05 Fisher test), sitting versus lateral decubitus (p=0.02), needle orientation not parallel to dural fibers (p=0.02); a trend was also observed for a lower frequency of headache in patients having undergone LP by smaller-diameter needles (22 Gauge). 83% of the patients were kept in bed rest for 24 hours. Despite the evidences favouring the use of smaller diameter, non-cutting needles and the lack of evidence in favour of bed rest after LP, this study has shown a very different clinical practice. The reasons for this discrepancy are manifold: consolidated habits, underestimation of the frequency-severity of post-LP headache, insufficient dissemination of existing guidelines.

Translated title of the contributionDiagnostic lumbar puncture: Study on the headache post-punction and systematic review of the literature
Original languageItalian
Pages (from-to)137-156
Number of pages20
JournalRivista Italiana di Neurobiologia
Volume3
Issue number2
Publication statusPublished - 2006

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology

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