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Postpunktionelles und spontanes Liquorunterdrucksyndrom

Post-lumbar puncture syndrome and spontaneous low CSF pressure syndrome

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Zusammenfassung

Die Liquorpunktion ist der invasive Eingriff des Neurologen schlechthin. Wichtigste Komplikation ist das postpunktionelle Syndrom. Leitsymptom ist lageabhängiger Kopfschmerz. Ursache ist ein Duraleck mit prolongiertem Liquoraustritt. In Abhängigkeit von der Punktionstechnik liegt dessen Inzidenz zwischen 1% und 30%. Wichtigste Maßnahme zur Reduktion des Risikos ist die Verwendung einer dünnen (22 Gauge), atraumatischen Sprotte- oder Whitacre-Nadel. Therapie der Wahl ist die Gabe von Koffein und bei Nichtansprechen der epidurale Blutpatch (mind. 20 ml Eigenblut). Das spontane Liquorunterdrucksyndrom beruht auf einem Einriss der Dura, zeigt die gleichen Symptome und in der MRT meist eine KM-Aufnahme der Meningen. Das spontane Liquorunterdrucksyndrom wird in den meisten Fällen erst nach Wochen bis Monaten diagnostiziert, sodass man bei allen chronischen Kopfschmerzen an dieses Syndrom denken sollte. Behandlung der Wahl sind ebenfalls Koffein und der epidurale Blutpatch. Bei Nichtansprechen kann das Leck mittels Radiozisternographie, Dünnschicht-MRT oder CT-Myelographie lokalisiert und ggfs. operativ oder per CT-gestützter Applikation von Fibrinkleber verschlossen werden.

Summary

The major invasive procedure of the neurologist is the spinal tap. Its most frequent complication is post-lumbar puncture syndrome/headache. The syndrome’s leading symptom is posture-dependent headache, which is caused by the prolonged escape of CSF from a dural leak. Its frequency lies between 1 and 30%, depending on the technique used for lumbar puncture. An important measure for reducing the risk of its occurrence is the use of a small (22-gauge), atraumatic Sprotte or Whitacre needle. The treatment of choice for the syndrome is caffeine, and if ineffective, then an epidural blood patch (at least 20 ml of the patient’s own blood). Spontaneous low CSF pressure is due to a dural tear; it has the same symptoms as post-dural puncture headache, and on MRI there is a contrast enhancement of the meninges. In most cases the spontaneous low CSF pressure syndrome only is diagnosed after weeks to months. For this reason one should consider this syndrome in all cases of chronic headache. It is also treated with caffeine and an epidural blood patch. If it persists, the leak must be localized by means of radioisotope cisternography, thin-layer MRI, or CT myelography, and then the hole is closed either surgically or by CT-assisted application of fibrin glue.

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  1. Neurologische Universitätsklinik der Ludwig-Maximilian-Universität, Klinikum Großhadern, Marchioninistraße 15, 81377, München, Deutschland

    M. Strupp

  2. Universitätsklinik für Neurologie, Universitätsklinikum Essen, Essen, Deutschland

    Z. Katsarava

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Strupp, M., Katsarava, Z. Postpunktionelles und spontanes Liquorunterdrucksyndrom. Nervenarzt 80, 1509–1519 (2009). https://doi.org/10.1007/s00115-009-2833-y

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