Pneumocephalus after spinal anesthesia

Case Report: Pneumocephalus after labor epidural anesthesia

Lumbar epidural anesthesia is commonly used for labor analgesia. The 'loss-of- resistance' to air technique (LORA) is generally employed for recognition of the epidural space. One of the rare complications of this technique is pneumocephalus (PC). Here we describe the case of a parturient who developed a frontal headache when locating the epidural space using LORA. On the second day after epidural injection, the patient exhibited occipital headaches with gradual worsening. Computed tomography scans of the brain indicated PC. Following symptomatic treatment, our patient was discharged on the 13th day. We concluded that the amount of air used to identify the epidural space in LORA should be minimized, LORA should not be used after dural puncture and the use of saline avoids PC complications.

Tension pneumocranium in childhood trauma

BACKGROUND

To report a case of fatal tension pneumocephalus in a 9-year-old boy following a severe motor vehicle accident.

METHODS

A young boy with a serious closed head injury was resuscitated in the emergency room and underwent CT scan of the head and orbits.

RESULTS

The CT-scan revealed a fracture of the orbital roof with extensive bilateral pneumocephalus.

CONCLUSIONS

A high index of suspicion for tension pneumocephalus is required in patients with severe head injuries presenting with periorbital swelling and perioccular trauma. A prompt CT scan and neurosurgical intervention are indicated.

Symptomatic tension pneumocephalus: An unusual post-operative complication of posterior spinal surgery

Pneumocephalus is a rare, but serious complication of spinal surgery and its management and physiology is not widely recognized. Symptomatic tension pneumocephalus secondary to iatrogenic cerebrospinal fluid (CSF) leak after surgical intervention, and drainage with a vacuum suction device, has not been previously reported. We report a patient who underwent intervertebral disc surgery who developed pneumoencephalus after drainage with a vacuum suction device. Imaging showed significant pneumocephalus in the subarachnoid space of the frontal region and in the cisterns. The condition was resolved by discontinuation of the suction drainage, bed rest and hyperhydration. Thus, spinal drainage may predispose to entry of air intracranially and pneumocephalus. It is important to be aware of this serious post-operative complication in patients with a CSF fistula.

Post-dural puncture headache, intracranial air and obstetric anesthesia

Recently, a controversy has arisen as to whether air or saline should be recommended for the correct localization of the epidural space with the loss of resistance technique. I report a case of a previously healthy parturient who developed pneumocephalus and severe headache following the use of the loss of resistance to air (LORA) technique to identify the epidural space. This case report raises one more time the question about the safety of the LORA technique for labor analgesia.

Temporary trigeminal disorder as a result of pneumocephalus after subarachnoid block

A patient was scheduled for inguinal herniorrhaphy under subarachnoid block. Lumbar puncture was difficult and several attempts were needed before it could be achieved. During the immediate postoperative period, the patient developed paraesthesia and anaesthesia on the right side of the face, mostly in the nose, cheek and upper lip areas. A CT scan showed a small pneumocephalus at the level of the brainstem. The symptoms persisted for approximately 70 min, after which they disappeared.

Pneumocephalus following an epidural blood patch

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.

[Pneumocephalus after spinal anesthesia]

We report the case of a 76-year-old man who received a spinal anaesthesia for inguinal hernia repair surgery. A cranial CT scan which was performed because the patient complained of postoperative headache and hemiparesis showed an important pneumocephalus. Because postoperative questioning revealed that the patient had a chronic and neglected rhinorrhea, we hypothesise that this pneumocephalus was secondary to an old unknown osteodural leak with intracranial air entry secondary to the spinal anaesthesia-releated decrease in CSF pressure.

Epidural and subarachnoidal pneumocephalus after epidural technique

Iatrogenic pneumocephalus is an uncommon complication observed after using the 'loss-of-resistance' technique with an air filled syringe. We report and review two cases of pneumocephalus: one subarachnoid and the other epidural.

Pneumocephalus following inadvertent intrathecal puncture during epidural anesthesia: a case report and review of the literature

Regional anesthesia techniques (epidural and spinal) are preferred anesthetic modalities in modern obstetrics, in that both of these modalities enable maternal participation in the delivery process and assist in avoiding maternal aspiration associated with general anesthesia. We report an unusual and potentially severe complication of epidural anesthesia for elective repeat cesarean delivery. Following intravenous hydration and lateral uterine displacement, uneventful epidural anesthesia was administered. Toward the end of the otherwise uneventful cesarean the patient, who had been completely stable, became unresponsive, with dilated pupils that did not respond to light. The patient was immediately intubated and gradually regained consciousness and was extubated within 1 h. Cranial computed tomography disclosed pneumocephalus. Inadvertent pneumocephalus is reviewed.

Radicular acute pain after epidural anaesthesia with the technique of loss of resistance with normal saline solution

Epidural anaesthesia using the loss of resistance to saline technique, without air, was successfully performed in a 65-year-old man scheduled for elective vascular surgery of the right leg. Epidural catheterisation was uneventful. Fifteen minutes after the initial dose of plain 0.5% bupivacaine, the patient experienced severe pain in his lower abdomen and legs which coincided with a supplementary injection of 2 ml bupivacaine and 50 microgram fentanyl, and a change from the lateral to the supine position. General anaesthesia was induced and CT and MRI scans were performed showing trapped air in the epidural space at the L4 level causing compression of the thecal sac. After excluding other causes, the spontaneous entry of air through the Tuohy needle was thought to be the most likely explanation for this complication. The patient recovered uneventfully.