Pneumocephalus after epidural injection: A rare complication of a common procedure

Sachdeva, S. P.; Sanwatsarkar, Sadhana; Maheshwari, Meghna; Singh, Priyank

doi:10.4103/ijpn.ijpn_75_17

Cited by 3 publications

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, obtaining the patient’s history of previous medical procedures is crucial for an accurate diagnosis [ 21 – 23 ]. Magnetic resonance imaging (MRI) with its excellent contrast resolution allows a straightforward characterization of the CSF pathway contamination.…”

Section: Discussionmentioning

confidence: 99%

Intracranial Transthecal Fat Migration After a Sacral Fracture: 2 Case Reports

et al. 2021

View full text Add to dashboard Cite

Case series Patients: Female, 84-year-old • Male, 60-year-old Final Diagnosis: Intraventricular fat droplets • sacral fracture extending into a large meningeal cyst Symptoms: Back pain • headache Medication: — Clinical Procedure: — Specialty: Neurology • Radiology Objective: Unusual clinical course Background: The presence of fat droplets within the subarachnoid space is an uncommon finding, which is almost exclusively associated with a ruptured dermoid cyst. In a trauma setting, transthecal migration of fat droplets is an extremely rare occurrence. We present 2 case reports of intracranial transthecal migration of fatty bone marrow after sacral fractures. Case Reports: Both patients presented to the Emergency Department (ED) after falls from a standing height. The first patient, an 84-year-old woman, suffered a stable sacral fracture extending into a large meningeal cyst within the right S2 foramen. Her initial neurological assessment and computed tomography (CT) of the head were un-remarkable. As the fracture did not require surgical treatment, she was discharged home and prescribed bed rest, analgesics, and venous thromboembolism prophylaxis. Three days after the injury, she was readmitted to the ED with a mild headache, dizziness, and an episode of nausea and vomiting. A follow-up head CT revealed fat droplets in the subarachnoid space and lateral ventricles. After successful symptomatic treatment, she was discharged home in good general condition. The second patient, a 60-year-old man, underwent a head CT for a scalp hematoma, which revealed fat droplets in the 3 rd ventricle and right lateral ventricle. The pelvic CT revealed a large sacral meningeal cyst with microfractures in its wall. He was discharged home on the same day and prescribed bed rest and analgesics. Conclusions: The detection of intracranial intrathecal fat droplets in association with a specific trauma mechanism should initiate the search for a sacral fracture.

show abstract

Section: Discussionmentioning

confidence: 99%

Intracranial Transthecal Fat Migration After a Sacral Fracture: 2 Case Reports

et al. 2021

View full text Add to dashboard Cite

show abstract

“…This retrospective study's question was to determine the local institutional incidence of radiologically evident presence of intracranial air (pneumocephalus) in peri-partum patients considering that many if not all peri-partum patients undergo neuraxial access attempts for labor analgesia, surgical anesthesia and post dural puncture headache managements in the form of epidurals, combined spinal-epidurals and epidural blood patches respectively wherein loss-of-resistance technique with air is most commonly utilized that can inadvertently inject air into epidural space that may indirectly travel into intrtathecal space unless inadvertent dural puncture during epidural access directly instills air into intrathecal space just like persistent air bubbles within the medication syringe while medication is being injected intrathecally during administration of spinal anesthesia [1][2][3][4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Risk Ratio (Relative Risk) And Odds Ratio For Radiologically Visible Intracranial Air After Neuraxial Access Attempts Among Our Peri-Partum Patients Were Undefined Although One In Forty Of Them Had Radiologically Visible Intracranial Air On CT/MR Of Head/Brain

Gupta

2022

Preprint

View full text Add to dashboard Cite

Background: During neuraxial access attempts, loss-of-resistance technique with air may inadvertently become injection-of-air technique potentially leading to intracranial air. Objective: The purpose of this retrospective study was to ascertain the incidence of radiologically visible intracranial air among peri-partum patients admitted to local Womens Hospital who underwent computed tomography/magnetic resonance imaging (CT/MR) of head/brain during their hospital stay at peri-partum floors over a seven-year period of July 1, 2015-June 30, 2022. Methods: After Institutional Review Board approval for exempt research, medical records of patients who underwent CT/MR of head/brain during their hospital stay at peri-partum floors over a seven-year period of July 1, 2015-June 30, 2022 were reviewed to see whether they had neuraxial access attempts (epidurals, spinals, combined spinal-epidurals, epidural blood patches) before their CT/MR of head/brain. Subsequently, such patients CT/MR of head/brain were reviewed to ascertain the evidence of any radiologically visible intracranial air. Results: Only 69 peri-partum patients underwent CT/MR of head/brain during the seven-year period with 40 of them receiving neuraxial access attempts before their CT/MR of head/brain. Only one labor epidural analgesia patient had radiologically visible intracranial air. Conclusion: In seven-year period sample among our peri-partum patients at local Womens Hospital, risk ratio (relative risk) and odds ratio for radiologically visible intracranial air after neuraxial access attempts were undefined although one in forty had radiologically visible intracranial air on CT/MR of head/brain after neuraxial access attempts and that intracranial air was 100% attributable to neuraxial access attempts.

show abstract

Rare Complication of Epidural Analgesia: Subcutaneous Cervical Emphysema

Tyagi¹,

Bhagat²

2022

Journal of South Asian Federation of Obstetrics and Gynaecology

View full text Add to dashboard Cite

As the demand for "painless labor" increases, lumbar epidural analgesia is increasingly being used in labor. It is generally a safe procedure; however, some rare cases of complications like subcutaneous cervical emphysema have been reported. Most common differential diagnosis is from postdural puncture headache (PDPH), definite diagnosis of which can be done with computed tomography (CT) and magnetic resonance imaging (MRI). We present a case of 34-year-old primigravida who went for epidural analgesia, underwent uneventful vaginal delivery. However, she had severe neck and shoulder pain postdelivery, which did not respond to regular treatment. After CT and MRI, diagnosis of subcutaneous cervical emphysema could be established, and after treating it, she settled down and was discharged.

show abstract

Pneumocephalus after epidural injection: A rare complication of a common procedure

Cited by 3 publications

References 0 publications

Intracranial Transthecal Fat Migration After a Sacral Fracture: 2 Case Reports

Intracranial Transthecal Fat Migration After a Sacral Fracture: 2 Case Reports

Risk Ratio (Relative Risk) And Odds Ratio For Radiologically Visible Intracranial Air After Neuraxial Access Attempts Among Our Peri-Partum Patients Were Undefined Although One In Forty Of Them Had Radiologically Visible Intracranial Air On CT/MR Of Head/Brain

Rare Complication of Epidural Analgesia: Subcutaneous Cervical Emphysema

Contact Info

Product

Resources

About