The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Kim, Yeon-Dong (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University) ;
  • Lee, Jae-Hun (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University) ;
  • Cheong, Yong-Kwan (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University)
  • Received : 2012.06.15
  • Accepted : 2012.08.23
  • Published : 2012.10.01
Download PDF
⟨ Previous Next ⟩

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

References

  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.
  2. Abouleish E, Goldstein M. Migration of an extradural catheter into the subdural space. A case report. Br J Anaesth 1986; 58: 1194-1197. https://doi.org/10.1093/bja/58.10.1194
  3. Bat T, Collins KK, Schaffer MS. Syncope during exercise: just another benign vasovagal event? Curr Opin Pediatr 2011; 23: 573-575. https://doi.org/10.1097/MOP.0b013e32834980b6
  4. Ajar AH, Rathmell JP, Mukherji SK. The subdural compartment. Reg Anesth Pain Med 2002; 27: 72-76. https://doi.org/10.1097/00115550-200201000-00013
  5. Collier CB. Why obstetric epidurals fail: a study of epidurograms. Int J Obstet Anesth 1996; 5: 19-31. https://doi.org/10.1016/S0959-289X(96)80070-7
  6. Reina MA, De Leon Casasola O, Lopez A, De Andres JA, Mora M, Fernandez A. The origin of the spinal subdural space: ultrastructure findings. Anesth Analg 2002; 94: 991-995. https://doi.org/10.1097/00000539-200204000-00040
  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. https://doi.org/10.1080/02841850600644766
  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. https://doi.org/10.1053/hn.1999.v120.a83901
  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. https://doi.org/10.3988/jcn.2008.4.2.89
  10. Benzon HT, Linde HW, Molloy RE, Brunner EA. Postdural puncture headache in patients with chronic pain. Anesth Analg 1980; 59: 772-774.
  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. https://doi.org/10.1097/00000542-199103000-00033
  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. https://doi.org/10.1016/j.ijoa.2005.10.011
  13. Kim YJ, Baik HJ, Kim JH, Jun JH. Pneumocephalus developed during epidural anesthesia for combined spinalepidural anesthesia. Korean J Pain 2009; 22: 163-166. https://doi.org/10.3344/kjp.2009.22.2.163
  14. Dexter F, Reasoner DK. Theoretical assessment of normobaric oxygen therapy to treat pneumocephalus. Anesthesiology 1996; 84: 442-447. https://doi.org/10.1097/00000542-199602000-00024
  15. Laviola S, Kirvela 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. https://doi.org/10.1213/00000539-199903000-00022
  16. Katz Y, Markovits R, Rosenberg B. Pneumoencephalos after inadvertent intrathecal air injection during epidural block. Anesthesiology 1990; 73: 1277-1279. https://doi.org/10.1097/00000542-199012000-00034
  17. Black PM, Davis JM, Kjellberg RN, Davis KR. Tension pneumocephalus of the cranial subdural space: a case report. Neurosurgery 1979; 5: 368-370. https://doi.org/10.1227/00006123-197909000-00012
  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.
  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. https://doi.org/10.4097/kjae.2008.55.3.387

Cited by

  1. Review of Medical Dispute Cases in the Pain Management in Korea: A Medical Malpractice Liability Insurance Database Study vol.28, pp.4, 2015, https://doi.org/10.3344/kjp.2015.28.4.254
  2. Pneumocephalus During Cervical Transforaminal Epidural Steroid Injections vol.94, pp.1, 2015, https://doi.org/10.1097/PHM.0000000000000165
  3. Pneumocephalus and Neurologic Deficit Due to Neck Stab Wound in a Twenty Nine-Year-Old Man vol.4, pp.4, 2016, https://doi.org/10.17795/rijm42336
  4. Cerebrospinal fluid infection after lumbar nerve root steroid injection: a case report vol.70, pp.1, 2017, https://doi.org/10.4097/kjae.2017.70.1.90
  5. Delayed post-operative tension pneumocephalus and pneumorrhachis pp.1432-0932, 2017, https://doi.org/10.1007/s00586-017-5268-3
  6. Case Report: Pneumocephalus after labor epidural anesthesia vol.3, pp.None, 2014, https://doi.org/10.12688/f1000research.4693.1
  7. Delayed Pneumocephalus Following Fluoroscopy Guided Cervical Interlaminar Epidural Steroid Injection : A Rare Complication and Anatomical Considerations vol.57, pp.5, 2012, https://doi.org/10.3340/jkns.2015.57.5.376
  8. Pneumocephalus after epidural analgesia: Should loss of resistance with air be blown out? vol.32, pp.2, 2012, https://doi.org/10.4103/0970-9185.173399
  9. Pneumocephalus after Interlaminar Lumbar Epidural Block vol.52, pp.6, 2012, https://doi.org/10.4055/jkoa.2017.52.6.552
  10. Atypical presentation of subdural block resulting in Horner’s syndrome and loss of consciousness vol.14, pp.9, 2021, https://doi.org/10.1136/bcr-2021-242622