A Symptomatic Pneumocephalus as a Complication of Lumbar Epidural Anaesthesia

Pires, Ana Sofia; Mendes, Teresa; Reis, Ana Areia; Pacheco, Ana Ferreira; Fagundes, Vitor; Mesquita, Mari

doi:10.12890/2020_001425

Cited by 2 publications

(2 citation statements)

References 13 publications

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“…Pneumocephalus symptoms usually begin shortly after an inadvertent dural puncture or when air is directly injected into the subdural region following loss of resistance [ 1 ]. Although delayed exaggeration or reappearance of symptoms has been reported in the literature, the total absence of any symptom shortly after the dural puncture and the introduction of air is extremely rare [ 1 , 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

Unusual Presentation of Pneumocephalus With Late Onset During Labour Epidural Analgesia

Riga¹,

Koursoumi²,

Kostopanagiotou³

et al. 2023

Cureus

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A 36-year-old woman with no significant medical history was in active labour and requested labour analgesia. While the epidural technique was performed at the L4-L5 interspace, using the loss of resistance to air technique (LORA), inadvertent dural puncture occurred. Since the patient reported no headache or discomfort, the same procedure was repeated at the L3-L4 interspace successfully. Loss of resistance was reported at 3 cm and the epidural catheter was advanced uneventfully at 8 cm. Aspiration was negative for blood or cerebrospinal fluid (CSF) and a test dose of 2 ml lidocaine 2% was administered epidurally. Within five minutes the patient exhibited a mild hypotensive episode successfully treated with 2.5 mg ephedrine IV, a sensory blockade up to T6 level, and a motor blockade up to T10 level. Both the woman’s and the baby’s vital signs remained stable, no further drugs were administered epidurally and labour progressed painlessly and uncomplicated for 90 minutes with subsequent vaginal delivery of a healthy newborn. During the episiotomy incision repair, the patient complained of light dizziness and nausea. Her vital signs and the arterial blood gases (ABGs) ordered were within normal range, but the neurological examination revealed an isolated Babinski on the right foot. The head CT scan requested indicated a considerable quantity of air within the subarachnoid region. The patient was treated conservatively; symptoms showed steady improvement with total resolution on the sixth day, and the woman was discharged. This case reemphasizes the possibility of pneumocephalus, which may, in reality, occur more frequently than is commonly recognized without a CT confirmation.

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Section: Discussionmentioning

confidence: 99%

Unusual Presentation of Pneumocephalus With Late Onset During Labour Epidural Analgesia

Riga¹,

Koursoumi²,

Kostopanagiotou³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…Moreover, pneumocephalus was reported as a complication of spinal anesthesia in 47% of cases, followed by myelography in 18%, diagnostic lumbar puncture in 12%, epidural anesthesia/injection in 11%, continuous spinal anesthesia in 4%, and other dural procedures accounting for 9%. 11 Few case reports identified this complication after epidural injection with an accidental dural puncture and is described in the literature as extremely rare, [12][13][14] and in one report, incidence was reported to be approximating 1-2 cases per year. 15 Currently, the incidence of pneumocephalus from lumbar punctures is not well described in the literature despite its risk from epidural injections reported as 1 in 67.…”

Section: Introductionmentioning

confidence: 99%

Spinal procedures, pneumocephalus, and cranial nerve palsies: A review of the literature

et al. 2023

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Purpose: Minimally invasive and surgical spine procedures are commonplace with various risks and complications. Cranial nerve palsies, however, are infrequently encountered, particularly after procedures such as lumbar punctures, epidural anesthesia, or intrathecal injections, and are understandably worrisome for clinicians and patients as they may be interpreted as secondary to a sinister etiology. However, a less commonly considered source is a pneumocephalus which may, in rare cases, abut cranial nerves and cause a palsy as a benign and often self-resolving complication. Here, we present the case of a patient who underwent an intrathecal methotrexate infusion for newly diagnosed non-Hodgkin’s T-cell lymphoma and subsequently developed an abducens nerve palsy due to pneumocephalus. We highlight the utility of various imaging modalities, treatment options, and review current literature on spinal procedures resulting in cranial nerve palsies attributable to pneumocephalus presenting as malignant etiologies.

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A Symptomatic Pneumocephalus as a Complication of Lumbar Epidural Anaesthesia

Cited by 2 publications

References 13 publications

Unusual Presentation of Pneumocephalus With Late Onset During Labour Epidural Analgesia

Unusual Presentation of Pneumocephalus With Late Onset During Labour Epidural Analgesia

Spinal procedures, pneumocephalus, and cranial nerve palsies: A review of the literature

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