【Headache after epidural block is the most frequent result of an unintentional dural puncture. This form of headache is usually caused by cerebrospinal fluid leakage through the dural puncture site. Another proposed cause of postdural puncture headache is the unintentional injection of air into the subarachnoid space. We experienced a case of severe headache with a patient after lumbar epidural block and discovered air in the intracranial subarachnoid space(pneumocephalus) with the aid of brain computerized tomography.】
An analytical review of the clinical records of 209 cases (6.0% of the operative conditions) of Surgical biliary tract diseases which had been operated at the Dept. of General surgery. Hanil Hospital for 9 2/1years from Jan. 1972 to Jun. 1980 showed the following results. 1) There were 99(47.3%) cases of cholecystitis with stone, 23(11.0%) cases of cholecystitis without stone, 32(15.3%) cases gallbladder empyema, 11(5.3%) cases of bile peritonitis, 13 (6.2%) cases of parasitic diseases, 12(5.6%)cases of malignant diseases and 11(5.1%) cases of others. 2) The sex ratio was 1 : 1.4 with male to female and the peak age distribution was in the 5th decade (24.9%) and in the 6th decade (24.4%). The average age was 47.4 years old. 3) The recent onset of less than 1 week were 94(45.0%) cases and the remote onset of more than 3 year were 93(44.5%) cases. 4) The incidence of cholelithiasis, 80 cases (59.7%), was more than that of the choledocholithiasis, 73 cases(B54.5%). The intrahepatic stone was confirmed in 22(10.5%) cases. 5) The cardinal symptoms and signs were RUQ pain (74.2%), nausea (39.2%), vomiting (35.9%), jaundice(31.2%), palpable gallbladder(32.5%), fever & chill(18.7%) and palpable liver (23.4%). 6) The average W.B.C. count was 10.100/cu.mm.(P.M.L.; 74%). The urine sugar was found in 17(8.4%) cases. 10 in 17 showed the increased level of serum amylase over 135 u The increase of total bilirubin level over 3.1mg% was 32.4%, of alkaline phosphatase over 2.3 u was 73.1%. of A/G ratio reverse was 12.1% and of the level of S.G.P.T. over 36 u was 51.1% 7) The stone shadow was identified in 11.6% on plain X-ray of the abdomen. Nonvisualization of gallbladder on the oral cholecystogram was found in 59(60.8%) cases and I.V. cholangiogram in 35 (71.4%) cases. 8) 21 in 52 cases showed no growth of bile culture. The most prominent E. coli was cultured in 10(32.3%) cases. 9) Cholecystectomy was performed in 170(81.3%) cases and the CBD exploration in 56 (74.6%) cases. The cholecystostomy was performed in 14(5.7%) cases.10) The postoperative complication rate was 31.6% and the mortality rate was 2.8%.
Headache after epidural block is the most frequent result of an unintentional dural puncture. This form of headache is usually caused by cerebrospinal fluid leakage through the dural puncture site. Another proposed cause of postdural puncture headache is the un- intentional injection of air into the subarachnoid space.
We experienced a case of severe headache with a patient after lumbar epidural block and discovered air in the intracranial subarachnoid space(pneumocephalus) with the aid of brain computerized tomography.
