Das Liquorunterdrucksyndrom

Zusammenfassung

Postpunktionelle Kopfschmerzen sind meist lageabhängig und treten nach diagnostischer Liquorpunktion oder Spinalanästhesie je nach Punktionstechnik in einer Häufigkeit von etwa 5 - 20 % bei jüngeren Patienten auf, wobei Frauen häufiger als Männer betroffen sind. Wenn die Beschwerden längere Zeit bestehen und nicht auf eine medikamentöse Therapie mit Koffein und Theophyllin ansprechen, ist die Therapie der Wahl die lokale Applikation eines epiduralen lumbalen Blutpatches. Bettruhe verhindert das Auftreten eines postpunktionellen Kopfschmerzes nicht. Beim spontanen lageabhängigen Kopfschmerz liegt meist ein spontanes Liquorleck vor. Dies zu lokalisieren ist häufig eine diagnostische Herausforderung. Spontane Liquorlecks werden zunächst ebenfalls mit einem Blutpatch behandelt. Ist die wiederholte Applikation eines Blutpatches therapeutisch nicht wirksam, muss eine ausführliche bildgebende Diagnostik ggf. mit Radiozisternographie, Dünnschicht-MR oder CT-Myelographie erfolgen.

Abstract

Post CSF puncture headache is posture dependent and has an incidence of 20 % following lumbar puncture or spinal anaesthesia. Younger age and female sex are predictors. Headache persisting for several days and not responding to caffeine and theophylline can be treated by local lumbar application of a blood patch. Bed rest is not effective. Spontaneous CSF leaks will also lead to posture dependent headaches. Spontaneous leaks can be treated with blood patches as well. In cases of treatment failure extensive imaging including cervical radioisotope application, high resolution MRI or CT myelography may be necessary.

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