Increased ICP

• Causes: Increased ICP
• Progressive
• Worsened when supine (Sleeping)
• Night-awakening
  • sleep → hypoventilation → increased PCO2 → vasodilation → increased CBF → increased ICP
• Aggregated by Valsalva maneuver (Bowl movement, exercise)
  • impaired venous return from lower extremity → increased CBF → increased ICP
  • impaired CSF flow exciting the cranium → increased ICP

Decreased ICP

Post-Dural Puncture Headache (PDPH)

• Causes: Neuroaxial Anesthesia, LP - Lumbar Puncture (Pa<25)
• Distribution is often frontal-occipital
• Symptoms are worse in the upright position and ease when supine
• PDPH may also be associated with Tinnitus  and Diplopia
• Most do not develop immediately after dural puncture, but 24-48 hrs after the procedure with 90% of headaches presenting within 3 days.

Treatment

• PDPH are usually self-limited, typically resolving within 1-2 weeks
• Epidural blood patch is used to hasten recovery from PDPH. It involves injection of sterile autologous blood into epidural space using the same loss of resistance technique as in epidural catheterization.