A Symptomatic Pneumocephalus as a Complication of Lumbar Epidural Anaesthesia

  • Ana Filipa Pires Serviço de Medicina Interna, Hospital Padre Américo, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
  • Teresa Martins Mendes Serviço de Medicina Interna, Hospital Padre Américo, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
  • Ana Areia Reis Serviço de Medicina Interna, Hospital Padre Américo, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
  • Ana Ferreira Pacheco Serviço de Medicina Interna, Hospital Padre Américo, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
  • Vítor Fagundes Serviço de Medicina Interna, Hospital Padre Américo, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
  • Mari Mesquita Serviço de Medicina Interna, Hospital Padre Américo, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal

Keywords

Pneumocephalus, lumbar epidural anaesthesia, post-dural puncture headache

Abstract

Introduction: Lumbar epidural anaesthesia is a commonly used technique for analgesia during labour. One of the rare complications of this technique is pneumocephalus.
Case description: We report the case of a 35-year-old female admitted to the Emergency Department with severe headache associated with fast head movements. Five days previously she had a eutocic delivery and lumbar epidural anaesthesia was performed. A brain computed tomography (CT) scan showed pneumocephalus and she was admitted to the hospital ward. A brain CT scan on the fourth day of hospitalization showed resolution of ventricular pneumocephalus.
Discussion: The most frequently occurring symptom with pneumocephalus is headache associated with fast brain motion resulting from air injection and meningeal irritation. When there is clinical suspicion of pneumocephalus, a brain CT scan should be performed for the diagnosis.

VIEW THE ENTIRE ARTICLE

References

  • Silva M, Halpern SH. Epidural analgesia for labor: current techniques. Local Reg Anesth 2010;3:143–153.

  • Pan PH, Bogard TD, Owen MD. Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries. Int J Obstet Anesth 2004;13:227–233.

  • Wang JC, Tsai SH, Liao WI. Pneumocephalus after epidural anesthesia in an adult who has undergone lumbar laminectomy. J Neurosurg Anesthesiol 2014;26:261–263.

  • Nafiu OO, Urquhart JC. Pneumocephalus with headache complicating labour epidural analgesia: should we still be using air? Int J Obstet Anesth 2006;15:237–239.

  • Aida S, Taga K, Yamakura T, Endoh H, Shimoji K. Headache after attempted epidural block: the role of intrathecal air. Anesthesiology 1998;88(1):76–81.

  • Alonso E, Parajua JL. [Iatrogenic pneumocephalus caused by epidural analgesia.] Neurologia 2000;15(9):418.

  • Mateo E, López-Alarcón MD, Moliner S, Calabuig E, Vivó M, De Andrés J, et al. Epidural and subarachnoidal pneumocephalus after epidural technique. Eur J Anaesthesiol 1999;16(6):413–417.

  • Reasoner DK, Todd MM, Scamman FL, Warner DS. The incidence of pneumocephalus after supratentorial craniotomy: observations on the disappearance of intracranial air. Anesthesiology 1994;80(5):1008–1012.

  • Peterson HO, Kieffer SA. Neuroradiology. Volume 1. New York: Hayon and Row; 1984, p. 127–130.

  • Finch MD, Morgan GA. Traumatic pneumocephalus following head injury. A complication of general anaesthesia. Anaesthesia 1991;46(5):385–387.

  • Candan S, Katelioglu M, Ceylan S, Köksal I. Otogenic brain abscess with pneumocephalus. Infection 1990;18(3):191–192.

  • Hawley JS, Ney JP, Swanberg MM. Subarachnoid pneumocephalus from epidural steroid injection. Headache 2005;45(3):247–248.

  • Simopoulos T, Peeters-Asdourian C. Pneumocephalus after cervical epidural steroid injection. Anesth Analg 2001;92(6):1576–1577.

  • Katz JA, Lukin R, Bridenbaugh PO, Gunzenhauser L. Subdural intracranial air: an unusual cause of headache after epidural steroid injection. Anesthesiology 1991;74(3):615–618.

  • Benzon HT, Linde HW, Molloy RE, Brunner EA. Postdural puncture headache in patients with chronic pain. Anesth Analg 1980;59(10):772–774.
  • Published: 2020-01-22

    Issue: Vol 7 No 2 (view)

    Section: Articles

    How to cite:
    1.
    Pires AF, Mendes TM, Reis AA, Pacheco AF, Fagundes V, Mesquita M. A Symptomatic Pneumocephalus as a Complication of Lumbar Epidural Anaesthesia. EJCRIM [Internet]. 2020Jan.22 [cited 2020Sep.25];7(2). Available from: https://www.ejcrim.com/index.php/EJCRIM/article/view/1425

    Most read articles by the same author(s)