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Pneumocephalus can be a cause of headache, but is easily overlooked in some clinical circumstances.
A 35-year-old woman developed severe headache of abrupt onset during an epidural blood patch procedure done for a post-lumbar puncture headache. A brain CT scan showed subarachnoid air even though there was no evidence of a dural puncture having occurred during the procedure.
The experience of our patient, and a review of the literature suggests that air injected into the epidural space during use of the “loss of resistance” technique can enter the subarachnoid space if a dural puncture site from a previous lumbar puncture is present.
Pneumocephalus should be considered as a potential cause for a severe headache occurring in association with epidural procedures, and also in a number of other clinical settings. Use of a high inspired air oxygen concentration can hasten absorption of an intracranial air collection.
Le pneumo-encéphale peut être une cause de céphalée, mais cette condition est ignorée dans certaines circonstances cliniques.
Une femme âgée de 35 ans a présenté une céphalée sévère d’apparition subite pendant un blood patch épidural effectué pour une céphalée suite à une ponction lombaire. Un CT scan cérébral a montré de l’air dans l’espace sous-arachnoïdien meme s’il n’y avait pas d’indication qu’il y avait eu perforation de la dure-mère pendant la manoeuvre.
L’expérience de notre patiente et une revue de la littérature suggèrent que l’air injecté dans l’espace épidural au moment de la technique de la “perte de résistance” peut pénétrer dans l’espace sous-arachnoïdien s’il existe une brèche de la dure-mère due à une ponction lombaire antérieure.
Le pneumo-encéphale devrait être considéré comme une cause possible de céphalée sévère suite à une épidurale ainsi que dans quelques autres circonstances cliniques. L’utilisation d’air à haute concentration d’oxygène peut hâter la résorption d’une collection intracrânienne d’air.
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