Pneumocephalus secondary to epidural analgesia: a case report

Abstract

Introduction: Epidural anesthesia is commonly used for analgesia during labor, and headache is a common complaint following this procedure. Pneumocephalus, on the other hand, is a rare and potentially serious complication of epidural anesthesia, which is most often caused by accidental puncture of the dura with the introduction of air into intrathecal space.

Case presentation: We present the case of a 19-year-old Hispanic female who developed a severe frontal headache and neck pain eight hours following epidural catheter placement to deliver analgesia during labor. Physical examination was within normal limits without any neurological deficits. Computed tomography of the head and neck would later demonstrate small to moderate amounts of pneumocephalus, predominantly within the frontal horn of the lateral ventricles, and a moderate amount of air within the spinal canal. She was treated conservatively with analgesia. Though headache recurred after discharge, repeat imaging showed improvement in the volume of pneumocephalus and conservative management was continued.

Conclusions: Although a rare complication and an uncommon cause of headache following epidural anesthesia, a high index of suspicion must remain for pneumocephalus as it may cause significant morbidity and, in some cases, be potentially life-threatening.

Keywords: Epidural anesthesia; Headache; Pneumocephalus; Post-dural puncture headache.

Fig. 1

Computed tomography head showing air predominantly within the frontal horn of the lateral ventricles without midline shift or mass effect. A Axial view, B Coronal view, C Sagittal view. Orange arrows identify the abnormal presence of air

Fig. 2

Computed tomography head showing air within the suprasellar cistern. Orange arrows identify the abnormal presence of air

Fig. 3

Computed tomography neck showing air within the cervical spinal canal. A Axial view, B Sagittal view. Orange arrows identify the abnormal presence of air

Fig. 4

Computed tomography Head on the second presentation showing improvement in the intracranial air. A Axial view, B Coronal view, C Sagittal view. Orange arrows identify the abnormal presence of air

Fig. 5

Computed tomography of the neck on the second presentation showing decreased small dorsal cervical/upper thoracic spine epidural air. A Axial view, B Sagittal view. Orange arrows identify the abnormal presence of air