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///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

Comparing diagnostic tests for post dural puncture headache

Abstract Number: 52
Abstract Type: Original Research

Rickie Nagpaul MB,BS,FRCA1 ; Shanmugasundaram Gowrie-Mohan MBBS,DA,FRCA2; Jamuna Navaratnarajah MBBS,FRCA3; Mark Hern MBBS, BSc,FRCA4; Omaima Glesa MBBS,FRCA5

Introduction: Diagnosis of post dural puncture headache (PDPH) is mainly based on clinical features. Pure tone audiometry, responses to epidural blood patch (EBP) and Gutsches test (manual pressure applied to the right upper quadrant of the abdomen causes significant reduction in the severity of headache) are helpful diagnostic tools. The aim of this study is to investigate how sensitive these diagnostic tests with clinically diagnosed PDPH patients.

Method: Patients were identified as part of an ongoing prospective audit of PDPH and its associated symptoms. Following ethics committee approval, One hundred and twenty one patients with clinically confirmed PDPH were recruited to take part in this study. Patients were asked to record the severity of headache in visual analogue scale before and after manual pressure applied to the upper quadrant of the abdomen. Pure tone audiometry was performed before and after Epidural Blood Patch. Each patients severity of PDPH, and the improvement after EBP were also recorded.

Results: Three patients were excluded because of unable to sit up long enough to do Gutsches test. Eighty six out of one hundred and eighteen patients (73%) had a subjective feeling of reduced severity of PDPH after Gutsches test. All one hundred and eighteen patients had improved hearing loss and improved sign and symptoms of PDPH after EBP.

Conclusion: From our series, Gutsches test is only 73% sensitive. Audiometry and response to EBP were 100% sensitive. However, Gutsches test may be a useful diagnostic tool in difficult PDPH syndrome.


1.Gutsche BB. Lumbar epidural analgesia in obstetrics: taps and patches. In: Reynolds F 9ed) Epidural and spinal blockade in obstetrics. London:Balliere tindall,1990;95-106.

SOAP 2010