Wednesday, March 11, 2009

Quincke II

This is a continuation of the previous case.

Your patient's clinical condition remains stable and her signs and symptoms begin improving but about 20 hours after presentation, she begins to complain of an occipital headache, nausea, and dizziness. You are on your neurology rotation and asked to consult. She has a history of migraine headaches but this feels different. There is no aura, photophobia, or phonophobia. Instead, she says the headache is worse when she sits up.

Challenge: As a consultant, what is your diagnosis? What is your treatment?

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2 comments:

Alex said...

post LP headache?

Craig Chen said...

Exactly!
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Quincke II

This is a post-lumbar puncture headache, occuring in 10-30% of LPs due to leakage of CSF from the dura with resulting traction on pain-sensitive structures. The differential diagnosis also includes central venous thrombosis. Headaches last 2-14 days and are more common in young females with a history of headache. Conservative treatment for the first 24 hours is recommended (bed rest and oral analgesics) followed by epidural blood patch, IV caffeine, and epidural saline. The title of the last two cases, Quincke, refers to the physician who did the first LP in 1891.

Sources: UpToDate; Wikipedia.