Ventricular Pneumocephalus with Meningitis after Lumbar Nerve Root Block

Abstract

Lumbar nerve root block is a common modality used in the management of radiculopathy. Its complications are rare and usually minor. Despite its low morbidity, significant acute events can occur. Pneumocephalus is an accumulation of air in the intracranial space. It indicates a violation of the dura or the presence of infection. The object of this report is to describe the case of a patient with intraventricular pneumocephalus and bacterial meningitis after lumbar nerve root block. A 70-year-old female was brought into emergency department with severe headache and vomiting which developed during her sleep. She had received lumbar nerve block for her radiculopathy one day before her presentation. Cranial computed tomography scan revealed a few hypodense lesions in her left lateral ventricle frontal horn and basal cistern indicating ventricular pneumocephalus. Five hours later, she developed sudden hearing loss. Cerebrospinal fluid analysis showed bacterial meningitis, and she was treated with high dose steroid and antibiotics. However, her impaired hearing as a sequela from meningitis was persistent, and she is still in follow-up. Intracranial complications of lumbar nerve root block including meningitis and pneumocephalus can occur and should be considered as high-risk conditions that require prompt intervention.

Characteristics of patients with meningitis after lumbar epidural steroid injection

“…Nevertheless, it could be a natural course of M-ESI regardless of the therapeutic strategy, considering the earlier reports where the patients fully recovered within several days only with conservative management without antibiotics or corticosteroids. [15,16] In the previous literature on M-ESI, the pathogen was identified in the CSF culture in some cases, [11,12] while others were not. [13][14][15][16] In the latter, there has been a doubt on whether M-ESI was indeed a bacterial infection, and so does our cases.…”

Psoas Abscess After Lumbar Facet Joint Injection: Case Report and Literature Review

“…Pyogenic arthritis of the lumbar facet joint is an extremely rare disorder, with an incidence rate of approximately 0.2% in reported spinal infections [13]. The literature presents infection cases post epidural injection for LBP in case report articles and small series [14][15][16]. Much more common are spondylodiscitis after facet joint steroid injection [17] and septic arthritis [18].…”

Cerebrospinal fluid infection after lumbar nerve root steroid injection: a case report

“…Unfortunately, some patients continue to experience complications associated with a nerve block, which can be lethal. Infectious complications of a lumbar nerve root block are rarely reported and are usually minor, but can be similar to those encountered after an epidural nerve block, such as an epidural abscess or pneumocephalus with meningitis [ 1 2 ]. Various guidelines are available to avoid infections, such as aseptic skin preparation, preventive antibiotics, and careful handling of instruments.…”

“…Although a headache caused by meningitis resulting from a CSF infection is rare, clinicians must be aware of this possibility when making the differential diagnosis. In other words, when a patient shows atypical clinical symptoms that obscure the clinical diagnosis after a lumbar nerve root steroid injection, a prompt work-up and procedures to address the complications should be implemented [ 2 ]. Even if the CSF was not infected, a steroid injection in the presence of an iliopsoas muscle infection could aggravate a local infection to become systemic bacteremia.…”