Subarachnoid and Subdural-Extraarachnoid Pneumocephalus in the Patient with No CSF LeaKage during Epidural Catheterization.
10.4097/kjae.2001.41.5.656
- Author:
Hyun Joo AHN
1
;
Woo SeoK SIM
;
Gaab Soo KIM
;
Youn Jung KANG
;
Yong chul KIM
Author Information
1. Pain Management Center of Samsung Medical Center, SungKyunKwan University School of Medicine, Seoul, Korea. mallang@hanmir.com
- Publication Type:Case Report
- Keywords:
Anesthetic techniques: epidural;
loss of resistance technique;
Complications: pneumocephalus
- MeSH:
Adult;
Brain;
Catheterization*;
Catheters*;
Female;
Headache;
Hearing;
Humans;
Nausea;
Neurologic Examination;
Pain Clinics;
Pneumocephalus*;
Punctures;
Radiculopathy;
Tinnitus
- From:Korean Journal of Anesthesiology
2001;41(5):656-659
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
A 43-year-old female patient with a left L5 radiculopathy was referred to our pain clinic for an epidural steroid injection. An epidural puncture was done at the L4-5 intervertebral space with the loss of resistance technique using air. There was no CSF leaKage during the procedure. After 6 ml of air was injected, she complained of a sudden severe headache, nausea, tinnitus, and mild hearing difficulty. The headache was localized at the left temporal and suboccipital area and the nature of it was constant, squeezing, and non-throbbing. Neurological examination was normal except a mild sensory change on the right face and right hemibody. A brain CT disclosed sudural and subarachnoid pneumocephalus. Twenty-four hours after the event, she was discharged without any specific complaints. To avoid pneumocephalus during epidural puncture, saline instead of air is highly recommended. If physicians use air, a small volume should be used and careful evaluation of the patients condition during injection despite no CSF leaKage should be done.
