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. 2020 Jan 22;7(2):001425.
doi: 10.12890/2020_001425. eCollection 2020.

Symptomatic Pneumocephalus as a Complication of Lumbar Epidural Anaesthesia

Ana Filipa Pires  1 , Teresa Martins Mendes  1 , Ana Areia Reis  1 , Ana Ferreira Pacheco  1 , Vítor Fagundes  1 , Mari Mesquita  1
Affiliations

Symptomatic Pneumocephalus as a Complication of Lumbar Epidural Anaesthesia

Ana Filipa Pires et al. Eur J Case Rep Intern Med. .

Abstract

Introduction: Lumbar epidural anaesthesia is a commonly used technique for analgesia during labour. One of the rare complications of this technique is pneumocephalus.

Case description: We report the case of a 35-year-old female admitted to the Emergency Department with severe headache associated with fast head movements. Five days previously she had a eutocic delivery and lumbar epidural anaesthesia was performed. A brain computed tomography (CT) scan showed pneumocephalus and she was admitted to the hospital ward. A brain CT scan on the fourth day of hospitalization showed resolution of ventricular pneumocephalus.

Discussion: The most frequently occurring symptom with pneumocephalus is headache associated with fast brain motion resulting from air injection and meningeal irritation. When there is clinical suspicion of pneumocephalus, a brain CT scan should be performed for the diagnosis.

Learning points: Pneumocephalus is the presence of air in the intracranial cavity and its development after spinal or epidural anaesthesia is extremely infrequent.Headache that occurs in the setting of lumbar epidural anaesthesia should not be labelled as post-dural puncture headache.The suspicion of pneumocephalus, based on the characteristics of the headache, should be maintained to obtain an emergent brain CT scan.

Keywords: Pneumocephalus; lumbar epidural anaesthesia; post-dural puncture headache.

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Conflict of interest statement

Conflicts of Interests: The Authors declare that there are no competing interests.

Figures

Figure 1
Figure 1
CT scan showing gas density in the upper vermian cistern and lateral ventricles
Figure 2
Figure 2
Brain CT scan showing pneumoventricle
Figure 3
Figure 3
Brain CT scan at discharge, without the presence of gas
See this image and copyright information in PMC

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