Pneumocephalus after Epidural Injection

J Emerg Med. 2018 Mar;54(3):e45-e47. doi: 10.1016/j.jemermed.2017.12.003. Epub 2017 Dec 30.

Abstract

Background: Pneumocephalus, or air in the intracranial space, is most commonly encountered after trauma or surgery. Epidural injections are commonly performed in obstetrics and pain management. Complications are uncommon and include hemorrhage, cerebrospinal fluid leak, and infection. A rare complication is pneumocephalus, described in only a few case reports of epidural anesthesia.

Case report: We describe a 34-year-old woman complaining of a generalized headache 6 days after an unremarkable vaginal delivery that was assisted by an epidural injection. A noncontrast computed tomography scan of the head revealed pneumocephalus secondary to epidural injection. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pneumocephalus is an uncommon but serious complication of an epidural procedure. Emergency physicians must be aware of this complication entity and maintain this entity in their differential diagnosis given the potential for significant morbidity.

Keywords: epidural; pneumocephalus; procedural complications.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cerebrospinal Fluid Leak / complications
  • Cerebrospinal Fluid Leak / etiology
  • Epidural Space / abnormalities
  • Epidural Space / diagnostic imaging
  • Female
  • Headache / etiology
  • Humans
  • Injections, Epidural / adverse effects*
  • Injections, Epidural / methods
  • Pneumocephalus / diagnostic imaging
  • Pneumocephalus / etiology*
  • Tomography, X-Ray Computed / methods