Lomber Ponksiyon Sonrası Gelişen Başağrısı ve Meningismus

Öz

Lomber ponksiyon sonrası en sık görülen komplikasyon baş ağrısıdır. Bu durumun persistant iğne giriş yerinde ortaya çıkan persistant beyin omurilik sıvı kaçağına ve beyin omurilik sıvı basıncının düşmesine ve meningeal ve kafa içi venlerin traksiyonu sonucu olduğu düşünülmektedir. Buna bağlı olarak bulantı, kusma ve vestibüler belirtiler ortaya çıkabilir. Meningeal irritasyon bulguları sunaraknoid kanama veya menenjit olmadığı sürece beklenmeyen klinik bulgulardır. Lomber ponksiyon sonrası ortaya çıkan başağrısı ve meningismus ile prezente olan bir olgu sumunu yaptık. Onyedi yaşında bayan hasta lomber pnksiyon yapıldıktan bir gün sonar ortaya çıkan baş ağrı, bulantı ve kusma şikayeti ile acil servise getirildi. Hastanın yaşamsal bulguları, fiziksel ve detaylı nörolojik muayenesi ense sertliği ve Brudziski bulgusu varlığı dışında normaldi. Bu bulgular olması nedeniyle menenjit veya sunaraknoid kanama tanısını araştırmak için lomber ponksiyon tekrarlandı. Beyin omurilik sıvı basıncı, protein, glukoz ve mikroskobik muayene ile kan ve beyin omurilik sıvı kültürleri normaldi. Son olarak yapılan manyetik rezonans görüntüleme tekniği ile meningeal tutulum araştırması da normaldi. Bu hastalardaki control edilmeyen iğne boyutu, hasta oryantasyonu, travmatilk lomber ponksiyondan kaçınma gibi nedenler çok dajha ciddi sonuçlar ortaya çıkarabilir. Ense sertliği, brudziski, kernig bulgusu gibi meningeal irritasyon bulguları lomber ponksiyon sonrası beklenmeyen fizik muayene bulgularıdır. Bu hastalarda mutlaka sunaraknoidal kanama ve meningeal infeksiyonların varlığı mutlaka araştırılmalıdır.

Anahtar Kelimeler

• Baş ağrısı, meningismus, lomber ponksiyon

Headache and Meningismus Following Lumbar Puncture

Öz

Post-lumbar puncture headache is the most common complication of lumbar puncture. This condition is thought to be the result of persistent cerebrospinal fluid leakage at the puncture site, leading to low cerebrospinal fluid pressure and traction on the meninges and intracranial veins. Associated symptoms may include nausea, vomiting, auditory and vestibular symptoms. Meningeal irritation signs are unexpected as clinical findings unless serious medical conditions such as subarachnoid hemorrhage or meningitis occur. We are present a case of headache and meningismus following by lumbar puncture. A 17-year-old female presented to the emergency department suffering from headache, nausea and vomiting, starting one day after a lumbar puncture procedure. The characteristics of the headache were different and more severe than the previous form. Her vital signs and physical and detailed neurological examination were normal, except meningismus findings such as neck stiffness and Brudzinksy’s sign. Since the meningismus findings were unexpected, lumbar puncture was performed again to diagnose meningitis and subarachnoid hemorrhage. Cerebrospinal fluid pressure, protein, glucose, microscopic examination, blood and cerebrospinal fluid cultures were normal. Finally, magnetic resonance imaging of the brain revealed no pathological meningeal enhancement. In patients harboring uncontrollable factors, variables such as needle size, bevel orientation and the avoidance of traumatic lumbar puncture should be taken into consideration more seriously than ever. Furthermore, since, meningeal irritation signs such as neck stiffness and Brudzinksy’s and Kernig’s signs are not the expected clinical findings of post-lumbar puncture headache, serious medical conditions such as subarachnoid hemorrhage and meningeal infections should be investigated in the emergency setting

Anahtar Kelimeler

• Headache, meningismus, lumbar puncture

Kaynakça

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