Korean J Pain.  2012 Oct;25(4):262-266. 10.3344/kjp.2012.25.4.262.

Pneumocephalus in a Patient with No Cerebrospinal Fluid Leakage after Lumbar Epidural Block: A Case Report

• Kim YD
• Lee JH
• Cheong YK

• KMID: 2278168
• DOI: http://doi.org/10.3344/kjp.2012.25.4.262

Abstract

Several complications are possible after a lumbar epidural block. However pneumocephalus are rare. In this case, we report a case of pneumocephalus. A 68-year-old male patient received lumbar epidural block with the loss of resistance technique using air, and after 35 minutes, apnea, unconsciousness, hypotension, and bradycardia occurred. Immediately, brain CT was done, and we found pneumocephalus. The patient complained of severe occipital headache and itchiness due to pneumocehalus. After conservative treatment, the patient recovered without neurologic complications, and on the seventh day of his hospitalization, he was discharged from the hospital.

Keyword

complication; epidural block; pneumocephalus; unconsciousness

MeSH Terms

Aged
Apnea
Bradycardia
Brain
Headache
Hospitalization
Humans
Hypotension
Male
Pneumocephalus
Unconsciousness

Figure

• 

  Fig. 1 This brain CT scan shows air-filled cavities in the parietal lobe and the sub-cortex of the frontal lobe (A), the anterior horn of the right temporal lobe (B), and the optic chiasm in front of pons and the sub-cortex of the right frontal lobe (C).

Reference

1. Collier CB. Accidental subdural injection during attempted lumbar epidural block may present as a failed or inadequate block: radiographic evidence. Reg Anesth Pain Med. 2004; 29:45–51. PMID: 14727278.

2. Abouleish E, Goldstein M. Migration of an extradural catheter into the subdural space. A case report. Br J Anaesth. 1986; 58:1194–1197. PMID: 3768232.

3. Bat T, Collins KK, Schaffer MS. Syncope during exercise: just another benign vasovagal event? Curr Opin Pediatr. 2011; 23:573–575. PMID: 21743327.

4. Ajar AH, Rathmell JP, Mukherji SK. The subdural compartment. Reg Anesth Pain Med. 2002; 27:72–76. PMID: 11799508.

5. Collier CB. Why obstetric epidurals fail: a study of epidurograms. Int J Obstet Anesth. 1996; 5:19–31. PMID: 15321378.

6. Reina MA, De Leon Casasola O, López A, De Andrés JA, Mora M, Fernández A. The origin of the spinal subdural space: ultrastructure findings. Anesth Analg. 2002; 94:991–995. PMID: 11916810.

7. Ozturk E, Kantarci M, Karaman K, Basekim CC, Kizilkaya E. Diffuse pneumocephalus associated with infratentorial and supratentorial hemorrhages as a complication of spinal surgery. Acta Radiol. 2006; 47:497–500. PMID: 16796314.

8. Clevens RA, Marentette LJ, Esclamado RM, Wolf GT, Ross DA. Incidence and management of tension pneumocephalus after anterior craniofacial resection: case reports and review of the literature. Otolaryngol Head Neck Surg. 1999; 120:579–583. PMID: 10187965.

9. Yoon SJ, Oh GS, Lee SJ, Lee BR, Chun JU, Yu IK. Pneumocephalus in patients with orthostatic headache. J Clin Neurol. 2008; 4:89–93. PMID: 19513309.

10. Benzon HT, Linde HW, Molloy RE, Brunner EA. Postdural puncture headache in patients with chronic pain. Anesth Analg. 1980; 59:772–774. PMID: 6448553.

11. Katz JA, Lukin R, Bridenbaugh PO, Gunzenhauser L. Subdural intracranial air: an unusual cause of headache after epidural steroid injection. Anesthesiology. 1991; 74:615–618. PMID: 1825771.

12. 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. PMID: 16798452.

13. Kim YJ, Baik HJ, Kim JH, Jun JH. Pneumocephalus developed during epidural anesthesia for combined spinal-epidural anesthesia. Korean J Pain. 2009; 22:163–166.

14. Dexter F, Reasoner DK. Theoretical assessment of normobaric oxygen therapy to treat pneumocephalus. Anesthesiology. 1996; 84:442–447. PMID: 8602677.

15. Laviola S, Kirvelä M, Spoto MR, Tschuor S, Alon E. Pneumocephalus with intense headache and unilateral pupillary dilatation after accidental dural puncture during epidural anesthesia for cesarean section. Anesth Analg. 1999; 88:582–583. PMID: 10072010.

16. Katz Y, Markovits R, Rosenberg B. Pneumoencephalos after inadvertent intrathecal air injection during epidural block. Anesthesiology. 1990; 73:1277–1279. PMID: 2248409.

17. Black PM, Davis JM, Kjellberg RN, Davis KR. Tension pneumocephalus of the cranial subdural space: a case report. Neurosurgery. 1979; 5:368–370. PMID: 503299.

18. van den Berg AA, Nguyen L, von-Maszewski M, Hoefer H. Unexplained fitting in patients with post-dural puncture headache. Risk of iatrogenic pneumocephalus with air rationalizes use of loss of resistance to saline. Br J Anaesth. 2003; 90:810–811. PMID: 12765902.

19. Lee SS, Lee SG, Min BW, Ban JS, Lee JH, Kim EJ. Pneumocephalus after an autologous blood patch procedure to treat a postdural puncture headache: A case report. Korean J Anesthesiol. 2008; 55:387–390.