Pneumocephalus and Sixth Nerve Palsy after Epidural Steroid Injection: Case Report and Review of the Literature

Li, Wendy F.; Kovacs, Kyle D.; Fisayo, Adeniyi

doi:10.1016/j.jemermed.2017.08.021

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…29,30 In contrast, as seen in our case, simple pneumocephalus can be benign with minimal symptoms and signs on examination which typically resolve independently (Table 1). 27,28…”

Section: Discussionmentioning

confidence: 99%

“…29,30 In contrast, as seen in our case, simple pneumocephalus can be benign with minimal symptoms and signs on examination which typically resolve independently (Table 1). 27,28 Most case reports to-date that highlight oculomotor nerve palsy had a pneumocephalus in the interpeduncular cistern where the nerve travels. 31 Laviola et al demonstrated a case of a pregnant patient who underwent an epidural anesthesia for labor and had developed a dilated and non-reactive pupil on the left, correlating with a pneumocephalus directly abutting the oculomotor nerve.…”

Section: Symptomatologymentioning

confidence: 99%

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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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“…29,30 In contrast, as seen in our case, simple pneumocephalus can be benign with minimal symptoms and signs on examination which typically resolve independently (Table 1). 27,28…”

Section: Discussionmentioning

confidence: 99%

Section: Symptomatologymentioning

confidence: 99%

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

et al. 2023

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“…2,5,6 In patients admitted to the ED in the early period after cranial or spinal surgery; PNC should be considered in the differential diagnosis if there is persistent headache, postoperative meningitis, post-surgical seizures abducens and oculomotor nerve palsy present. 1,2,7,8 Nowadays; lumbar disc surgery can be performed under both spinal anesthesia and general anesthesia. Each has possible disadvantages and advantages.…”

Section: Discussionmentioning

confidence: 99%

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mentioning

confidence: 99%

Tension Pneumocephalus Unexpected Complication Following Lumbar Disc Surgery

Öztürk¹,

ÖZSARAÇ²,

YÜRÜMEZ³

et al. 2022

Turkiye Klinikleri J Case Rep

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Pneumocephalus (PNC) is an unusual but critical complication of epidural procedures and spine surgery only a few cases have been reported in the literature. 1,2 It is an abnormal presence of air in the cranium and usually caused by traumatic head injuries, infectious gas-forming bacteria, brain tumors, cranial surgeries, spontaneous autogenic factors, otorhinolaryngology procedures and diagnostic interventions such as lumbar puncture. 3 Magnetic resonance imaging can be definitive in the diagnosis but is less sensitive than computed tomography (CT) scans. CT imaging is the gold standard imaging technique for the diagnosis of PNC. 2 In this text; we present and discuss a case of PNC who presented to the emergency department (ED) with headache and change in mental status following lumbar disc surgery. CASE REPORTA 67-year-old female patient with worsening headache and change in mental status was presented to the ED. In her medical history, it has been learned that she had undergone lumbar disc surgery for L1-5 herniation four days. Her history was positive for epilepsy, hypertension, and deep vein thrombosis, and she was using phenytoin. At the time of admission, vital signs of the patient were normal except for 130 beats heart rate tachycardia. She was drowsy, nonoriented and non-cooperative. The Glaskow Coma Score was 12 (E3M5V4). Muscle strength and deep tendon reflexes were normal and bilaterally symmetrical. The rest of the physical examination was normal. Electrolytes, complete blood count, arterial blood gases, liver and kidney function tests, and cardiac markers were normal. Non-contrast brain-CT revealed PNC in the fronto-temporal fossa (Figure 1). There was no midline shift or mass effect. Also, pneumatization in the supraorbital region was also attracted attention. The patient was given antiemetics and analgesics and admitted. The patient was transferred to the neurosurgery intensive care unit for clinical observation.

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Pneumocephalus induced isolated oculomotor palsy :Case report and literature review

Alturkistani¹,

Altuhayni²,

Alluhaybi³

et al. 2020

Interdisciplinary Neurosurgery

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Pneumocephalus and Sixth Nerve Palsy after Epidural Steroid Injection: Case Report and Review of the Literature

Cited by 4 publications

References 7 publications

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

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

Tension Pneumocephalus Unexpected Complication Following Lumbar Disc Surgery

Pneumocephalus induced isolated oculomotor palsy :Case report and literature review

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