Acute Onset Headache Complicating Labor Epidural Caused by Intrapartum Pneumocephalus

Smarkusky, Loren; DeCarvalho, Helena; Bermudez, Ady; González-Quintero, Víctor Hugo

doi:10.1097/01.aog.0000209185.54752.48

Cited by 12 publications

(1 citation statement)

References 8 publications

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“…Despite its dramatic appearance, there have been no known deaths as a result of pneumocephalus [ 11 ]. The precise neurological symptoms caused by the presence of air in the cranium are determined by the intracranial distribution of air bubbles, while the length and severity of the symptoms are determined by the volume of air present in the skull [ 2 ].…”

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%