Servus Xelya,
das ist zwar nun überhaupt nicht mein Fachgebiet, aber mir sind halt einige Quellen zugänglich, die man nur als Weißkittel zur Verfügung hat.
ich stelle einen Text hier ein, damit Du sehen kannst, daß Das kein einfaches Problem ist. Vielleicht ist der Augenarzt allein da nicht ganz der Richtige. Also - laß Dir von einem Neurochirutgen erklären, wie dieser Text zu verstehen ist.
Mechanisms behind postspinal headache and brain stem compression following lumbar dural puncture–a physiological approach.
Grande PO
Acta Anaesthesiol Scand 2005 May;49(5):619-26.
Department of Anesthesia and Intensive Care, University and University Hospital of Lund, SE-221 85 Lund, Sweden. [email protected] FAU - Grande, P-O
PMID: 15836674 [PubMed - indexed for MEDLINE]
BACKGROUND: The cause of postspinal headache and its specific characteristics are unknown, and whether lumbar dural puncture (LP) triggers brain-stem compression in patients with brain oedema is still controversial. METHODS: Hydrostatic effects of distal opening of the dural sac towards the atmosphere are described and applied to the normal brain and the brain with disrupted BBB. Analogue analyses from previous results using an isolated skeletal muscle enclosed in a rigid shell were applied to the brain in an attempt to simulate and verify the haemodynamic effects of distal opening of the spinal canal. RESULTS: The theoretical considerations and the experimental results are compatible with the hypothesis that hydrostatic effects of distal opening of the fluid-filled spinal canal may obliterate the normal subdural venous collapse after a change from the horizontal to vertical position, which may be compatible with postural postspinal headache as occurring close to pain-sensitive meningeal regions. The hydrostatic forces may also initiate transcapillary filtration and aggravate oedema when permeability is increased, which may cause a narrower situation in the brain stem region, perhaps aggravated by venous stasis and a Cushing reflex-induced increase in blood pressure. An magnetic resonance imaging (MRI) picture illustrates how this scenario may separate the subdural space into an upper high- and a lower low-pressure cavity, pressing the brain downwards with sagging of the brain. A life-threatening positive feedback situation for brain-stem compression may develop. CONCLUSION: The present study strongly suggests that postspinal headache and brain-stem compression and other LP-related effects are predictable following LP, without involving CSF leakage, and can be explained by hydrostatic effects triggered by distal opening of the normally closed dural space to the atmosphere.
Stichworte:
Adolescent, Brain Stem/*injuries, Dura Mater/*physiology, Female, Headache/cerebrospinal fluid/*etiology/*physiopathology, Humans, Intracranial Pressure/physiology, Magnetic Resonance Imaging, Meningitis, Bacterial/cerebrospinal fluid/pathology, Spinal Puncture/*adverse effects
Kai
[Bei dieser Antwort wurde das Vollzitat nachträglich automatisiert entfernt]
Aussage der Neurologen in der Uniklinik: „Das geht nicht einfach so durch Absetzen des Medikaments wieder weg“; der Beipackzettel sagt:„Nach Absetzen des Medikaments reversibel“.