Long-Term Epidural Patching Outcomes and Predictors of Benefit in Patients With Suspected CSF Leak Nonconforming to ICHD-3 Criteria.

التفاصيل البيبلوغرافية
العنوان:	Long-Term Epidural Patching Outcomes and Predictors of Benefit in Patients With Suspected CSF Leak Nonconforming to ICHD-3 Criteria.
المؤلفون:	Carroll I; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Han L; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Zhang N; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Cowan RP; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Lanzman B; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Hashmi S; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Barad MJ; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Peretz A; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Moskatel L; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Ogunlaja O; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Hah JM; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Hindiyeh N; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Barch C; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Bozkurt S; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Hernandez-Boussard T; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora., Callen AL; From the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.
المصدر:	Neurology [Neurology] 2024 Jun 25; Vol. 102 (12), pp. e209449. Date of Electronic Publication: 2024 May 31.
نوع المنشور:	Journal Article
اللغة:	English
بيانات الدورية:	Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0401060 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1526-632X (Electronic) Linking ISSN: 00283878 NLM ISO Abbreviation: Neurology Subsets: MEDLINE
أسماء مطبوعة:	Publication: Hagerstown, MD : Lippincott Williams & Wilkins Original Publication: Minneapolis.
مواضيع طبية MeSH:	Blood Patch, Epidural/methods , Cerebrospinal Fluid Leak/therapy , Intracranial Hypotension*/therapy, Humans ; Female ; Male ; Middle Aged ; Adult ; Prospective Studies ; Case-Control Studies ; Treatment Outcome ; Cohort Studies ; Patient Reported Outcome Measures
مستخلص:	Background and Objectives: Spinal CSF leaks lead to spontaneous intracranial hypotension (SIH). While International Classification of Headache Disorders, Third Edition (ICHD-3) criteria necessitate imaging confirmation or low opening pressure (OP) for SIH diagnosis, their sensitivity may be limited. We offered epidural blood patches (EBPs) to patients with symptoms suggestive of SIH, with and without a documented low OP or confirmed leak on imaging. This study evaluates the efficacy of this strategy. Methods: We conducted a prospective cohort study with a nested case-control design including all patients who presented to a tertiary headache clinic with clinical symptoms of SIH who completed study measures both before and after receiving an EBP between August 2016 and November 2018. Results: The mean duration of symptoms was 8.7 ± 8.1 years. Of 85 patients assessed, 69 did not meet ICHD-3 criteria for SIH. At an average of 521 days after the initial EBP, this ICHD-3-negative subgroup experienced significant improvements in Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical Health score of +3.3 (95% CI 1.5-5.1), PROMIS Global Mental Health score of +1.8 (95% CI 0.0-3.5), Headache Impact Test (HIT)-6 head pain score of -3.8 (95% CI -5.7 to -1.8), Neck Disability Index of -4.8 (95% CI -9.0 to -0.6) and PROMIS Fatigue of -2.3 (95% CI -4.1 to -0.6). Fifty-four percent of ICHD-3-negative patients achieved clinically meaningful improvements in PROMIS Global Physical Health and 45% in HIT-6 scores. Pain relief following lying flat prior to treatment was strongly associated with sustained clinically meaningful improvement in global physical health at an average of 521 days (odds ratio 1.39, 95% CI 1.1-1.79; p < 0.003). ICHD-3-positive patients showed high rates of response and previously unreported, treatable levels of fatigue and cognitive deficits. Discussion: Patients who did not conform to the ICHD-3 criteria for SIH showed moderate rates of sustained, clinically meaningful improvements in global physical health, global mental health, neck pain, fatigue, and head pain after EBP therapy. Pre-treatment improvement in head pain when flat was associated with later, sustained improvement after EBP therapy among patients who did not meet the ICHD-3 criteria. Classification of Evidence: This study provides Class IV evidence that epidural blood patch is an effective treatment of suspected CSF leak not conforming to ICHD-3 criteria for SIH.
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تواريخ الأحداث:	Date Created: 20240531 Date Completed: 20240531 Latest Revision: 20240714
رمز التحديث:	20240714
مُعرف محوري في PubMed:	PMC11244740
DOI:	10.1212/WNL.0000000000209449
PMID:	38820488
قاعدة البيانات:	MEDLINE

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تدمد:	1526-632X
DOI:	10.1212/WNL.0000000000209449