Pneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological Presentation (original) (raw)
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The Journal of Critical Care Medicine, 2021
Introduction Neuraxial techniques, including epidural anaesthesia, are often used for perioperative pain control and are generally safe. However, both transient, mild and even severe, life-threatening neurologic complications can occur. Case presentation A seventy-eight-year-old man was admitted to the hospital for a radical nephrectomy plus transurethral resection due to kidney and bladder cancer. During the epidural exploration, an accidental dural puncture was noted. This was followed by the patient complaining of an intense headache. The epidural catheter was placed in a different location, and surgery was performed uneventfully. The patient presented with confusion, agitation, vertical nystagmus, vision loss, and paraparesis about two hours later. The epidural levobupivacaine and morphine infusion were stopped, followed by motor block resolution. A computerized head-tomography scan showed extra-axial multiple air spots involving the frontal and temporal lobes. Emergent hyperbar...
Journal of Clinical Anesthesia, 1994
We rejxn-t a case of pneumocephalus following the attempted treatment of a postdural puncture headache @ a continuous epidural saline infusion. Within 1 hour of infusion, symptoms of a severe headache, nausea, and vomitingprompted a computerized tomographic scan of the head that showed 12 to 15 ml of air in the cranium. The epidural space was located easily with the loss-ofresistance technique using3 ml of air A saline bolus and infusion were initiated after confirmation of correct placement of the epidural catheter We suggest that air passed from the negativepressure tpidural space through the duralpuncture created ip the diagnostic spinal tap, producing a pneumocephalus.
Pneumocephalus after lumbar epidural catheter: A case report
2014
Various complications have been associated with epidural block; pneumocephalus is one of the rare complications.We report a case of pneumocephalus following epidural catheter placement in a 58 years old female patient referredto our pain clinic for pain hypogastrium. After careful history and physical examination the diagnosis of neuropathicpain was established. The pain did not relieve with the pharmacological treatment, so superior hypogastric ganglionblock was performed. The patient remained pain free for a week, after which the complaints recurred. Then an epiduralcatheter was attempted twice but abandoned after two failed attempts. The catheter perforated the dura mater leadingto flow of CSF. After a few hours the patient developed a complaint of severe headache. The patient was hospitalisedand intravenous NSAID’s were started. However, the headache did not relieve, so CT scan brain was ordered, whichdetermined the presence of pneumocephalus. The patient was offered symptomatic...
Pneumocephalus and Seizure in Patient after Epidural Lumbar Puncture: Case Report
Archives of Anesthesia and Critical Care, 2020
Lumbar epidural analgesia is using widely as an alternative method for anesthesia. Although it has its benefits such as the low risk of complications in contrast with general anesthesia, also it has some adverse effects, for instance: headache, loss of consciousness, pneumocephalus, dizziness, and seizure. Pneumocephalus is a rare complication of lumbar epidural block. In this case of study, a patient represents stenosis in the site of anastomosis of colon and duodenum candidate for a repair surgery with the lumbar epidural block. Epidural catheter insertion was done in the sitting position; local anesthesia was administered at the 4th and 5th lumbar vertebral interspace. A 17-gauge Husted needle was inserted using the loss-of resistance (LOR) by air technique. Immediately the patient complained of headaches and then deteriorated to a tonic-clonic movement accompanied by post-seizure sleep, which ended up in termination of the procedure. The first-day CT-scan revealed multiple pneum...
A rare case of pneumocephalus and pneumorrhachis after epidural anesthesia
Acta Anaesthesiologica Taiwanica, 2015
Both pneumocephalus and pneumorrhachis are rare but serious complications following epidural anesthesia. We report a rare case of simultaneous pneumocephalus and pneumorrhachis in a patient after undergoing epidural anesthesia. The patient lost consciousness and received emergent external ventricular drainage for pneumocephalus in another medical center. The patient was clear after external ventricular drain placement until 4 days later, when sudden onset of subdural hemorrhage occurred and an emergent craniectomy was performed. The patient passed away 2 days after craniectomy, due to multiorgan failure. Pneumocephalus with or without pneumorrhachis should be kept in mind when there is a sudden change of consciousness or persistent convulsions after epidural anesthesia.
Post-dural puncture posterior reversible encephalopathy syndrome
2011
We report the case of a young patient with 36 weeks pregnancy, and an acute respiratory infection with severe bronchospasm, who developed an occipital headache and neck pain on the third day of inadvertent dural puncture during placement of combined epidural spinal anaesthesia for caesarian section. It was diagnosed as post-dural puncture headache until generalised tonic clonic siezures occurred the
Case Report: Pneumocephalus after labor epidural anesthesia
F1000research, 2014
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.