P025: PNEUMOCEPHALUS FOLLOWING EPIDURAL ANALGESIA
William A Perez Morales, MD1; Guillermo Loyola Loyola, OMSIII2; Dagoberto J Morales, MD1; Michael Minichiello, DO1; Ahmed Ibrahim, DO1; Fuhbe Mfone, DO1; Christopher King, DO1; 1Palmetto General Hospital; 2Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine
Introduction: Pneumocephalus is a complication of lumbar analgesia. It occurs when air or gas is introduced into the intracranial cavity, leading to an increase in intracranial pressure and the development of neurological symptoms.
Case Description: A 24-year-old G2P1 woman was admitted for a scheduled cesarean section. Epidural analgesia was administered for pain control. After the procedure, the patient developed severe headaches. Neuroimaging revealed pneumocephalus. The patient was treated with conservative management, including bed rest, oxygen, and pain control. She was discharged on day-4 after clinical improvement and resolution of pneumocephalus.
Figure 1. Pneumocephalus
Discussion: Pneumocephalus is a rare but potentially serious complication of epidural and spinal anesthesia.1 It is usually caused by a tear in the dura mater, which allows air or gas to escape into the intracranial cavity.2 The development of pneumocephalus can lead to increased intracranial pressure and the development of neurological symptoms, including headache, nausea, and confusion.3 In this case, the patient developed headaches following epidural analgesia during a cesarean section. The patient was treated with conservative management and the pneumocephalus resolved without further complication.
Conclusion: This case report highlights the importance of recognizing and treating pneumocephalus, a rare but potentially serious complication of epidural and spinal anesthesia.
1. Reddi S, Honchar V, Robbins MS. Pneumocephalus associated with epidural and spinal anesthesia for labor. Neurol Clin Pract. 2015 Oct;5(5):376-382. doi: 10.1212/CPJ.0000000000000178. PMID: 29443169; PMCID: PMC5762022.
2. Manuel Á. Gómez-Ríos, María Concepción Fernández-Goti; Pneumocephalus after Inadvertent Dural Puncture during Epidural Anesthesia. Anesthesiology 2013; 118:444 doi: https://doi.org/10.1097/ALN.0b013e31825e6ecc
3. Eddins M, Klucsarits S. Subdural pneumocephalus complicating labor epidural analgesia. Int J Obstet Anesth. 2017 May;31:109-110. doi: 10.1016/j.ijoa.2017.05.003. Epub 2017 May 10. PMID: 28684137.