Use of Intravenous Tetracosactin in the Treatment of Postdural Puncture Headache: Our Experience in Forty Cases
2002; Lippincott Williams & Wilkins; Volume: 94; Issue: 5 Linguagem: Inglês
10.1097/00000539-200205000-00069
ISSN1526-7598
AutoresLuz Cánovas, Carmen Barros, A Gómez, Marcos Dopico Castro, Andrés Castro,
Tópico(s)Spine and Intervertebral Disc Pathology
ResumoTo the Editor: Adrenocorticotropic hormone (ACTH) for treatment of Postdural Puncture Headache (PDPH) has been briefly mentioned in literature (1–4). We present the use of tetracosactin in 40 patients suffering PDPH. All patients presented with severe headache in the occipital region that worsened in the upright position, associated in most cases with nausea and vomiting (5). Tetracosactin, which contains the first 24 amino acids of the natural ACTH sequence and has the same physiological properties, was administered. Saline solution 1.5 U/kg in 250 mL was administered over 30 min (2,3). Pain intensity was evaluated after 6, 24, and 72 h post-therapy. After 6 h, 38 patients of the study presented complete pain relief, which remained in further controls. The ACTH-induced production of aldosterone causes an increase in the intravascular volume and may determine the closure of the orifice by others means: dural edema or by physical opposition of the dural orifice margins (6). It has been speculated with the possibility of ACTH increasing CSF production, through a sodium active transport mechanism, and a possible increase in the production of β endorphins in the central nervous system with a subsequent increase in pain threshold (1,4). We believe that IV ACTH is an effective alternative to conservative therapy in PDPH. Luz Cánovas, MD, PhD Carmen Barros Ana Gómez Marcos Castro Andrés Castro
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