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Failure of Oblique Needle Insertion to Prevent Post-Lumbar Puncture Headache

James I. Morrow, MB, MRCP; Alison McAuley, SRN; Victor H. Patterson, MB, MRCP
Arch Neurol. 1987;44(8):795-795. doi:10.1001/archneur.1987.00520200003001
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To the Editor.  —Post-lumber puncture headache (PLPH) remains a significant problem in clinical practice, occurring after approximately 30% of lumbar punctures (LPs).1 Over 40 different factors that might influence the incidence of PLPH have been considered by as many authors. Despite the voluminous literature, there remains a lack of convincing evidence of a relationship with any of these factors, apart, perhaps, from needle size, for which the data are reasonably strong in favoring the use of smaller needles.2It has been suggested by Thorsen3 that the hole produced by an oblique or tangential insertion of the needle should heal faster than that produced when the needle is inserted perpendicularly. Hatfalvi4 reported no headaches in a personal series of 600 spinal anesthetics, and he attributed this to his preferred technique of lateral or oblique insertion of the spinal needle. His explanation for this finding was that the dural and arachnoid holes did

REFERENCES

Tourtellotte WW, Haerer AF, Heller GL, et al: Post-Lumbar Puncture Headaches . Springfield, Ill, Charles C Thomas Publishers, 1964;.
Vandam LD, Dripps RD:  Long-term follow-up of patients who received 10 098 spinal anesthetics . JAMA 1956;;161:586-591.
Thorsen G:  Neurological complications after spinal anaesthesia and results from 2493 follow-up cases . Acta Chir Scand 1947;;95( (suppl 121) ):1.
Hatfalvi BI:  The dynamics of post-spinal headache . Headache 1977;;17:64-66.

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Tourtellotte WW, Haerer AF, Heller GL, et al: Post-Lumbar Puncture Headaches . Springfield, Ill, Charles C Thomas Publishers, 1964;.
Vandam LD, Dripps RD:  Long-term follow-up of patients who received 10 098 spinal anesthetics . JAMA 1956;;161:586-591.
Thorsen G:  Neurological complications after spinal anaesthesia and results from 2493 follow-up cases . Acta Chir Scand 1947;;95( (suppl 121) ):1.
Hatfalvi BI:  The dynamics of post-spinal headache . Headache 1977;;17:64-66.

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