Pneumocephalus and Seizures Following Combined Spinal-epidural for Labor

Abstract

(J Clin Anesth. 2018;44:123–124) In this correspondence, the authors described a patient who presented with simultaneous pneumocephalus and cavernoma after receiving combined spinal-epidural analgesia for labor. However, unlike most cases of combined spinal-epidural analgesia for labor, which use loss of resistance to air to identify the epidural space, the authors used loss of resistance to saline. To the author’s knowledge, there are no published reports of the use of loss of resistance to saline for this purpose. Identification of the epidural space was successful upon the fourth attempt with the patient in a sitting position. Upon injection of local anesthetic, the patient immediately complained of a severe headache, that was unremitting with postural changes and continued into the postpartum period. On postpartum day 2, the patient presented with a tonic-clonic seizure. Magnetic resonance imaging showed intraventricular pneumocephalus and cavernoma in the right frontal region, and electroencephalogram showed abundant epileptic activity. Oxygen was added to the patient’s therapy with clinical improvement; complete reabsorption of air on radiologic examination was seen on the sixth day and the asymptomatic patient was discharged.

Total Diz Replasmanı Olacak Hastada Kombine Spinal Epidural Anestezi ile Oluşan Pnömosefali: Olgu Sunumu

“…7 Jones ve arkadaşları sıvı ile direnç kaybı yöntemiyle başarılı bir şekilde uyguladıkları epidural anestezi sonrasında ani gelişen başağrısı, takip eden günde ise tonik-klonik kasılmalar izlemişler ve non-operatif şekilde takip ederek hastanın iyileştiğini bildirmişlerdir. 8 Lomber epidural steroid enjeksiyonu uygulanırken gelişen dural ponksiyon sonrasında hastada ani başağrısı gelişmesi üzerine BT görüntülenmesi yapılmış ve pnömosefali tanısı konulmuştur. Hastanın genel durumu değerlendirilerek konservatif tedavi (ağrı kesici, oksijen, 10 ° baş aşağı pozisyon) ile hasta takip edilmiş ve 2. haft a alınan kontrol BT' de pnömosefalinin tamamen iyileştiği görülmüştür.…”

Pneumocephalus and air travel: an experimental investigation on the effects of aircraft cabin pressure on intracranial pressure

“…The formation of cracks across the surface of agarose gel reported in "Effects of ICA volume ≥ 30 ml" section suggests that it may not be safe for pneumocephalus patients with ICA volumes of 30 ml or larger to embark on air travel, as this may lead to complications due to elevated ICP and cerebral herniation. Large expansion of ICA may also lead to more severe neurological disorders such as epilepsy 29 and focal neurological deficits, depending on the location of the ICA within the brain 30,31 . Although the experiments performed in "Effects of ICA volume ≤ 20 ml and ROC" section were limited only to 15 mmHg, the 30 ml threshold for unsafe travel applies also to other values of initial ICP.…”