Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
Pain Med. 2009 Nov;10(8):1469-75. doi: 10.1111/j.1526-4637.2009.00727.x. Epub 2009 Oct 26.
To describe the unusual course of postdural puncture headache (PDPH) after pump implantation for intrathecal baclofen (ITB) administration in patients with complex regional pain syndrome (CRPS)-related dystonia.
Case series based on data collected from 1996 to 2005. Setting. Movement disorders clinic, university hospital.
A total of 54 patients with CRPS-related dystonia who were treated with ITB.
A high incidence (76%) and prolonged course (median 18 days, range 2 days to 36 months) of PDPH was found. Radionuclide studies performed in two patients with long-lasting symptoms (12-16 months) did not reveal cerebrospinal fluid (CSF) leakage. In patients without signs of CSF leakage (N = 38), epidural blood patches administered in 24 patients were effective in 54%, while ketamine infusions administered in six patients were effective in 67%.
Our observations may suggest that other mechanisms besides intracranial hypotension play a role in the initiation and maintenance of PDPH in CRPS and stimulate new directions of research on this topic.
描述鞘内注射巴氯芬（ITB）治疗复杂区域疼痛综合征（CRPS）相关肌张力障碍患者在植入泵后发生慢性硬膜穿刺后头痛（PDPH）的不寻常病程。
基于 1996 年至 2005 年期间收集的数据进行的病例系列研究。设置：运动障碍诊所，大学医院。
共 54 例 CRPS 相关肌张力障碍患者接受 ITB 治疗。
发现 PDPH 的发生率较高（76%），且病程较长（中位数为 18 天，范围为 2 天至 36 个月）。对两名持续症状长达 12-16 个月的患者进行放射性核素研究并未发现脑脊液（CSF）漏出。在没有 CSF 漏出迹象的患者（N=38）中，24 例患者接受硬膜外血贴治疗，有效率为 54%，6 例患者接受氯胺酮输注治疗，有效率为 67%。
我们的观察结果可能表明，除颅内低血压外，其他机制也可能在 CRPS 中 PDPH 的发生和维持中起作用，并为该主题的研究开辟新的方向。
