J Korean Neurosurg Soc.  2015 May;57(5):376-378. 10.3340/jkns.2015.57.5.376.

Delayed Pneumocephalus Following Fluoroscopy Guided Cervical Interlaminar Epidural Steroid Injection: A Rare Complication and Anatomical Considerations

• Kim YD
• Ham HD
• Moon HS
• Kim SH

• KMID: 1881737
• DOI: http://doi.org/10.3340/jkns.2015.57.5.376

Abstract

Cervical epidural steroid injection is indicated for radicular symptoms with or without axial neck pain. Complications are rare but can be serious. Here, we report the case of a 54-year-old man with cervical radicular pain who was treated with cervical epidural steroid injection. Injection was administered twice under fluoroscopic guidance with the loss-of-resistance technique using air to confirm the epidural space. After the second procedure, the patient complained of severe persistent headache and was diagnosed with pneumocephalus on brain computed tomography. The patient returned home without any neurological complication, after a few days of conservative treatment. Though, a fluoroscopic guidance cervical epidural injection is also known to diminish the risk of complications. Physicians should always keep in mind that it does not guarantee safety, particularly in the cervical region, related to its anatomical considerations.

Keyword

Cervical epidural steroid injection; Complication; Pneumocephalus

MeSH Terms

Brain
Epidural Space
Fluoroscopy*
Headache
Humans
Injections, Epidural
Middle Aged
Neck Pain
Pneumocephalus*

Figure

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  Fig. 1 Axial brain CT scan shows pneumocephalus (arrow).

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  Fig. 2 Follow up brain CT scan shows dissolved pneumocehpalus on next 16 days.

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