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LONG-TERM FOLLOW-UP OF PATIENTS WHO RECEIVED 10,098 SPINAL ANESTHETICS: Title and subTitle BreakSYNDROME OF DECREASED INTRACRANIAL PRESSURE (HEADACHE AND OCULAR AND AUDITORY DIFFICULTIES) FREE

Leroy D. Vandam, M.D.; Robert D. Dripps, M.D.
[+] Author Affiliations

This study was supported in part by a contract with the Office of the Surgeon General, United States Army.


Philadelphia

From the Department of Anesthesiology, University of Pennsylvania School of Medicine. Dr. Vandam is now at the Peter Bent Brigham Hospital, Boston.


JAMA. 1956;161(7):586-591. doi:10.1001/jama.1956.02970070018005
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• The headache that frequently follows spinal anesthesia is sometimes associated with visual and auditory difficulties and dizziness. This syndrome was studied in connection with 9,277 anesthetizations by the spinal technique, and the data were compared with those from 1,000 other patients who were given general anesthesia over the same period of time.

The over-all incidence of the headache, which occurred in 9,277 anesthetizations, was 1,011, or 11%. The oldest patients were least susceptible to it, and men were less susceptible than women. Its incidence when needles of small diameter were used was much less than that with needles of large diameter; the 22-gauge needle was found best for routine use. Headache could be virtually eliminated by the employment of a 24-gauge needle. The data on duration and time of onset of the headache, on the effects of postural changes, and on the visual and auditory phenomena indicate that this syndrome results from a decrease in cerebrospinal fluid pressure and that the decrease is caused by leakage of the fluid.

REFERENCES

Todd, D., and Beecher, H. K.:  Study of the Deaths Associated with Anesthesia , Ann. Surg. 140:2-34, 1954;.
Price, H. L., and Helrich, M.:  The Effect of Cyclopropane, Diethyl Ether, Nitrous Oxide, Thiopental, and Hydrogen Ion Concentration on the Myocardial Function of the Dog Heart-Lung Preparation , J. Pharmacol. & Exper. Therap. 115:206-216, 1955;.
Habif, D. V., and others:  Renal and Hepatic Blood Flow, Glomerular Filtration Rate, and Urinary Output of Electrolytes During Cyclopropane, Ether, and Thiopental Anesthesia, Operation, and Immediate Post-Operative Period , Surgery 30:241-255, 1951;.
Cole, F.:  A Defense of Spinal Anesthesia , Anesthesiology 13:407-415, 1952;.
Dripps, R. D., and Vandam, L. D.:  Long-Term Follow-Up of Patients Who Received 10,098 Spinal Anesthetics: Failure to Discover Major Neurological Sequelae , J. A. M. A. 156:1486-1491 ( (Dec. 18) ) 1954;.
Vandam, L. D., and Dripps, R. D.:  Long-Term Follow-Up of Patients Who Received 10,098 Spinal Anesthetics: Incidence and Analysis of Minor Sensory Neurological Defects , Surgery 38: 463-469, 1955;.
Page, F.:  Intracranial Hypotension , Lancet 1:1-5, 1953;.
Thorsen, G.:  Neurological Sequelae After Spinal Anesthesia and Results from 2,493 Follow-Up Cases , Acta chir. scandinav. ( (supp. 121) ) 95: 1-272, 1947;.
Pearson, G. H.:  Effect of Age on Vibratory Sensibility , Arch. Neurol. & Psychiat. 20:482 ( (Sept.) ) 1928;.
Dripps, R. D., and Vandam, L. D.:  Hazards of Lumbar Puncture , J. A. M. A. 147:1118-1121 ( (Nov. 17) ) 1951;.
 Corrections: Spinal Anesthetics, Medical News , J. A. M. A. 157: 455 ( (Jan. 29) ) 1955;.
Greene, B. A.:  A 26-Gauge Lumbar Puncture Needle: Its Value in the Prophylaxis of Headache Following Spinal Analgesia for Vaginal Delivery , Anesthesiology 11:464-469, 1950;.
Dripps, R. D.:  A Comparison of the Malleable Needle and Catheter Technics for Continuous Spinal Anesthesia , New York J. Med. 50: 15951599, 1950;.
Wolff, H. G.: Headache, and Other Head Pain , New York, Oxford University Press, 1948;,  chap. 2 .
Redlich, F. C.; Moore, B. D., and Kimbell, I., Jr.:  Lumbar Puncture Reactions: Relative Importance of Physiological and Psychological Factors , Psychosom. Med. 8:386-398, 1946;.
Verjaal, A., and Kraft, T. B.:  Is Completely Horizontal Position Necessary After Lumbar Puncture? Nederl. tijdschr. geneesk. 98: 1493-1494, 1954;.
Torda, C., and Wolff, H. G.:  Experimental Studies on Headache: Transient Thickening of Cranial Arteries in Relation to Certain Phenomena of Migraine Headache and Action of Ergotamine Tartrate on Thickened Vessels , Arch. Neurol. & Psychiat. 53: 329-332, 1945;.
Hughson, W.:  A Note on the Relationship of Cerebrospinal and Intralabyrinthine Pressures , Am. J. Physiol. 101:396-407, 1932;.

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Todd, D., and Beecher, H. K.:  Study of the Deaths Associated with Anesthesia , Ann. Surg. 140:2-34, 1954;.
Price, H. L., and Helrich, M.:  The Effect of Cyclopropane, Diethyl Ether, Nitrous Oxide, Thiopental, and Hydrogen Ion Concentration on the Myocardial Function of the Dog Heart-Lung Preparation , J. Pharmacol. & Exper. Therap. 115:206-216, 1955;.
Habif, D. V., and others:  Renal and Hepatic Blood Flow, Glomerular Filtration Rate, and Urinary Output of Electrolytes During Cyclopropane, Ether, and Thiopental Anesthesia, Operation, and Immediate Post-Operative Period , Surgery 30:241-255, 1951;.
Cole, F.:  A Defense of Spinal Anesthesia , Anesthesiology 13:407-415, 1952;.
Dripps, R. D., and Vandam, L. D.:  Long-Term Follow-Up of Patients Who Received 10,098 Spinal Anesthetics: Failure to Discover Major Neurological Sequelae , J. A. M. A. 156:1486-1491 ( (Dec. 18) ) 1954;.
Vandam, L. D., and Dripps, R. D.:  Long-Term Follow-Up of Patients Who Received 10,098 Spinal Anesthetics: Incidence and Analysis of Minor Sensory Neurological Defects , Surgery 38: 463-469, 1955;.
Page, F.:  Intracranial Hypotension , Lancet 1:1-5, 1953;.
Thorsen, G.:  Neurological Sequelae After Spinal Anesthesia and Results from 2,493 Follow-Up Cases , Acta chir. scandinav. ( (supp. 121) ) 95: 1-272, 1947;.
Pearson, G. H.:  Effect of Age on Vibratory Sensibility , Arch. Neurol. & Psychiat. 20:482 ( (Sept.) ) 1928;.
Dripps, R. D., and Vandam, L. D.:  Hazards of Lumbar Puncture , J. A. M. A. 147:1118-1121 ( (Nov. 17) ) 1951;.
 Corrections: Spinal Anesthetics, Medical News , J. A. M. A. 157: 455 ( (Jan. 29) ) 1955;.
Greene, B. A.:  A 26-Gauge Lumbar Puncture Needle: Its Value in the Prophylaxis of Headache Following Spinal Analgesia for Vaginal Delivery , Anesthesiology 11:464-469, 1950;.
Dripps, R. D.:  A Comparison of the Malleable Needle and Catheter Technics for Continuous Spinal Anesthesia , New York J. Med. 50: 15951599, 1950;.
Wolff, H. G.: Headache, and Other Head Pain , New York, Oxford University Press, 1948;,  chap. 2 .
Redlich, F. C.; Moore, B. D., and Kimbell, I., Jr.:  Lumbar Puncture Reactions: Relative Importance of Physiological and Psychological Factors , Psychosom. Med. 8:386-398, 1946;.
Verjaal, A., and Kraft, T. B.:  Is Completely Horizontal Position Necessary After Lumbar Puncture? Nederl. tijdschr. geneesk. 98: 1493-1494, 1954;.
Torda, C., and Wolff, H. G.:  Experimental Studies on Headache: Transient Thickening of Cranial Arteries in Relation to Certain Phenomena of Migraine Headache and Action of Ergotamine Tartrate on Thickened Vessels , Arch. Neurol. & Psychiat. 53: 329-332, 1945;.
Hughson, W.:  A Note on the Relationship of Cerebrospinal and Intralabyrinthine Pressures , Am. J. Physiol. 101:396-407, 1932;.
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