• Alexander G Munts, Joan H C Voormolen, Johan Marinus, Elmar M Delhaas, and Jacobus J van Hilten.
• Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
• Pain Med. 2009 Nov 1; 10 (8): 1469-75.

ObjectiveTo describe the unusual course of postdural puncture headache (PDPH) after pump implantation for intrathecal baclofen (ITB) administration in patients with complex regional pain syndrome (CRPS)-related dystonia.DesignCase series based on data collected from 1996 to 2005. Setting. Movement disorders clinic, university hospital.PatientsA total of 54 patients with CRPS-related dystonia who were treated with ITB.ResultsA high incidence (76%) and prolonged course (median 18 days, range 2 days to 36 months) of PDPH was found. Radionuclide studies performed in two patients with long-lasting symptoms (12-16 months) did not reveal cerebrospinal fluid (CSF) leakage. In patients without signs of CSF leakage (N = 38), epidural blood patches administered in 24 patients were effective in 54%, while ketamine infusions administered in six patients were effective in 67%.ConclusionsOur observations may suggest that other mechanisms besides intracranial hypotension play a role in the initiation and maintenance of PDPH in CRPS and stimulate new directions of research on this topic.

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