Blood patch after tap with borderline elevated opening pressure

[Crybaby]

Anyone have experience with this?

My new young and crazy patient who I have seen just one time. Psych mess, new lupus/ RA, horrible diabetic, prinzmetal angina ended up at the ED Tuesday complaining of migraine headache (not new)
She told them it felt like she had meningitis and bought herself a spinal tap. All normal, though opening pressure at 25. Most sources state normal is 7-15. I have seen a few that extend to 20-25.

She calls our office last night and our on call doc (did not know entire story) set her up with blood patch with me today! Yay!

When getting time set..... she would not come in until after her rheumatology appointment. So that leads me to think headache is not that bad.

No neurology consult I have seen yet. Neurology not taking calls for "outside patients".

What would you all do, I am leaning towards getting a neurology consult first to cover my bases. Am I overreacting?

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[lobelsteve]

4 days of fluids before attempting. Dump it on IR.

 

[willabeast]

Tell patient you will write a work excuse until HA better, and do conservative treatment. This almost always works. Personally, i would not let anyone inject blood into my epidural space for a transient problem . Think about it - what would you do? What would you suggest for your mama? Just be sure patient knows to call you for any changes in condition.

 

[Ducttape]

anesthesiology suggested to your mama that she could have a blood patch for her PDPH epidural after giving birth to you...


all kidding aside, agree with holding off, emphasizing hydration, caffeine, bedrest for 3 days prior to attempting any blood patch.

opening pressures are often done incorrectly in the ER. confirm that it was 25 cm and not 25 mm, and that it was in lat decub position. (25 is upper end normal: CSF opening pressure: Reference interval and the effect of body mass index)


highest opening pressure I ever "saw" was never measured. pre "CT for everything" day, as a med student, I assisted on an LP. the stylet flew out and struck the resident in the chest as he got in. he was pretty calm under fire. put finger over needle, quickly (like in .1 seconds) got 5 cc of fluid, then took whole needle out in less than 10 seconds.

we did neuro checks for like hours wondering if and when he would herniate.

 

[pastafan]

Fioricet plus hydration is useful.

 

[Tapspatellas]

SPG, hold on the EBP unless that doesn't do it.