Pain physician
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A 39-year-old woman with no history of trauma or meningitis presented to the neurology department of our hospital with an occipital headache, neck pain, nausea, and dizziness that had worsened during the previous month. The headache worsened when sitting or standing and partially regressed when lying down. She was diagnosed with spontaneous intracranial hypotension (SIH) and received conservative management. ⋯ Follow-up magnetic resonance imaging (MRI) showed the disappearance of abnormal radiological features associated with intracranial hypotension. She currently remains symptom free for 9 months. Delivery of autologous blood patch via a cervical epidural Racz catheter inserted from the upper thoracic spine can be a safe and effective method for patients with SIH due to cerebrospinal fluid (CSF) leakage in the upper cervical spine.
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The major component of a systematic review is assessment of the methodologic quality and bias of randomized and nonrandomized trials. While there are multiple instruments available to assess the methodologic quality and bias for randomized controlled trials (RCTs), there is a lack of extensively utilized instruments for observational studies, specifically for interventional pain management (IPM) techniques. Even Cochrane review criteria for randomized trials is considered not to be a "gold standard," but merely an indication of the current state of the art review methodology. Recently a specific instrument to assess the methodologic quality of randomized trials has been developed for interventional techniques. ⋯ We have developed a new comprehensive instrument to assess the methodological quality of nonrandomized studies of interventional techniques. This instrument provides extensive information specific to interventional techniques is useful in assessing the methodological quality and bias of observational studies of interventional techniques.