Pneumocephalus in a Patient with No Cerebrospinal Fluid Leakage after Lumbar Epidural Block - A Case Report -
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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.Keywords:
Pneumocephalus
Unconsciousness
Epidural block
Pneumocephalus can originate from accidental dural puncture while performing epidural block using the loss-of-resistance (LOR) technique with an air-filled syringe.We present two cases of pneumocephalus after lumbar epidural block under fluoroscopy for pain control in elderly patients.Lumbar epidural block should be performed under fluoroscopic guidance in elderly patients with severe lesions. The physician should be aware of the increased possibility of a dural puncture occurring due to anatomical changes in older patients. The use of saline is recommended for the LOR technique. A contrast injection should be used together with the LOR technique to locate the epidural space. If a dural puncture occur, the patient should be carefully monitored to determine whether pneumocephalus has developed.
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Pneumocephalus is a rare complication of epidural block. We report a case of pneumocephalus complicating an epidural blood patch performed 3 days after unintentional dural puncture. Pneumocephalus may occur during an epidural blood patch procedure, even if the epidural needle tip is within the epidural space.
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In Brief Pneumocephalus is a well known complication of spinal and epidural anesthesia, but it is extremely rare after diagnostic or therapeutic lumbar puncture. This uncommonness can obscure the clinical diagnosis and lead to unnecessary procedures and prolonged patient discomfort. We report a 72-yr-old woman with normal pressure hydrocephalus who underwent an unremarkable lumbar puncture that was complicated by a postprocedure pneumocephalus that manifested as a continuous headache. The pneumocephalus resolved spontaneously after 4 days. Possible mechanisms for this occurrence, along with steps that can be taken to prevent this complication, are discussed. IMPLICATIONS: We report a case of symptomatic pneumocephalus in a woman with normal pressure hydrocephalus after an unremarkable lumbar puncture. The possible mechanisms for this occurrence, along with steps that can be taken to prevent this complication, are discussed.
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April 24, 2018April 10, 2018Free AccessStroke-like Symptoms following a Lumbar Epidural Block: A Rare Case Report of Pneumocephalus (P3.243)Nicholas Lannen, Brandon Francis, and Muhammad FarooqAuthors Info & AffiliationsApril 10, 2018 issue90 (15_supplement) Letters to the Editor
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Pneumocephalus is a rare complication of anesthetic procedures involving the epidural space. With the loss of resistance technique using air, air may be injected in through the dural puncture site. Epidural blood patch was performed for the treatment of post-lumbar puncture headache, and 10 minutes after the treatment, 8 ml of 0.5% bupivacaine hydrochloride was injected through epidural catheter. Loss of consciousness and apnea were developed about 8 minutes after injection of local anesthetics. Computerized tomographic brain scan revealed the presence of air within intracranial cavity. Pneumocephalus may be symptomatic or asymptomatic. It generally responds well to conservative management. The patient did not complain of a headache. The patient was discharged from the hospital on the seventh day postpartum with no neurologic sequelae. (Korean J Anesthesiol 1997; 33: 997∼1000)
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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.
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Epidural steroid injection is one method of releiving chronic back pain. However, problems with the loss of resistance to air technique include the possible subarachnoid or subdural injection of air resulting in headache, venous air embolism, and the introduction of air bubbles into the epidural space. Pneumocephalus is a rare complication of epidural block for epidural steroid injection. We report a case of a 58-year-old woman who developed a severe headache and posterior nuchal pain with incomplete oculomotor palsy due to pneumocephalus occuring after an epidural steroid injection.
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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.
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Background: Pneumocephalus can be a cause of headache, but is easily overlooked in some clinical circumstances. Case Study: A 35-year-old woman developed severe headache of abrupt onset during an epidural blood patch procedure done for a post-lumbar puncture headache. A brain CT scan showed subarachnoid air even though there was no evidence of a dural puncture having occurred during the procedure. Results: The experience of our patient, and a review of the literature suggests that air injected into the epidural space during use of the “loss of resistance” technique can enter the subarachnoid space if a dural puncture site from a previous lumbar puncture is present. Conclusion: Pneumocephalus should be considered as a potential cause for a severe headache occurring in association with epidural procedures, and also in a number of other clinical settings. Use of a high inspired air oxygen concentration can hasten absorption of an intracranial air collection.
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