Hostname: page-component-84b7d79bbc-2l2gl Total loading time: 0 Render date: 2024-07-30T01:20:17.141Z Has data issue: false hasContentIssue false
  • English
  • Français

Pneumocephalus as a Cause for Headache

Published online by Cambridge University Press:  02 December 2014

W.J. Becker
W.J. Becker*
Affiliation:
University of Calgary and Calgary Health Region, Calgary, Alberta, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Pneumocephalus can be a cause of headache, but is easily overlooked in some clinical circumstances.

Case Study:

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.

Results:

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.

Conclusion:

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.

Résumé:

RÉSUMÉ:Introduction:

Le pneumo-encéphale peut être une cause de céphalée, mais cette condition est ignorée dans certaines circonstances cliniques.

Étude de cas:

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.

Résultats:

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.

Conclusions:

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.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 3 , August 2002 , pp. 278 - 281
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

References

1. Krisanda, TJ, Laucks, SO. Pneumocephalus following an epidural blood patch procedure: an unusual cause of severe headache. Ann Emerg Med 1994;23(1):129–131.Google Scholar
2. Vasdev, GM, Chantigian, RC. Pneumocephalus following the treatment of a postdural puncture headache with an epidural saline infusion. J Clin Anesth 1994;6:508–511.Google Scholar
3. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain. Cephalalgia 1988;8(Suppl 7):1–96.Google Scholar
4. González-Carrasco, FJ, Aguilar, JL, Llubiá, C, Nogués, S, Vidal-López, F. Pneumocephalus after accidental dural puncture during epidural anesthesia. Reg Anesth 1993;18:193–195.Google Scholar
5. Lucas, DN, Kennedy, A, Dob, DP. Dural puncture and iatrogenic pneumocephalus with subsequent transverse myelitis in a parturient. Can J Anesth 2000;47(11):1103–1106.Google Scholar
6. Hogan, QH, Haddox, JD. Headache from intracranial air after a lumbar epidural injection: subarachnoid or subdural? Reg Anesth 1992;17:303–305.Google ScholarPubMed
7. Roderick, L, Moore, DC, Artru, AA. Pneumocephalus with headache during spinal anesthesia. Anesthesiology 1985;62(5):690–692.CrossRefGoogle ScholarPubMed
8. Dexter, F, Reasoner, DK. Theoretical assessment of normobaric oxygen therapy to treat pneumocephalus. Anesthesiology 1996;84(2):442–447.Google Scholar
9. Laviola, S, Kiervelä, M, Spoto, M-R, Tschuor, S, Alon, E. Pneumocephalus with intense headache and unilateral pupillary dilatation after accidental dural puncture during epidural anesthesia for Cesarean section. Anesth Analg 1999;88:582–583.Google ScholarPubMed
10. Ruge, JR, Cerullo, LJ, McLone, DG. Pneumocephalus in patients with CSF shunts. J Neurosurg 1985;63:532–536.Google Scholar
11. Labadie, EL, Hamilton, RH, Lundell, DC, Bjelland, JC. Hypoliquor-reic headache and pneumocephalus caused by thoraco-subarachnoid fistual. Neurology 1977;27:993–995.Google Scholar
12. Brown, WH, Stothert, JC. Traumatic subarachnoid-pleural fistula. J Trauma 1985;25(11):1105–1107.Google ScholarPubMed
13. Kiu, M-C, Wan, Y-L, Ng, S-H, Lee, S-T, Hao, S-P. Pneumocephalus due to nasopharyngeal carcinoma: case report. Neuroradiology 1996;38:70–72.Google Scholar
14. Hayman, LA, Carter, K, Schiffman, JS, Tang, RA. A sellar misadventure - imaging considerations. Surv Ophthalmol 1996;42:252–254.Google Scholar
15. Maier, W, Fradis, M, Scheremet, R. Spontaneous otogenic pneumocephalus. Ann Otol Rhinol Laryngol 1996;105:300–302.Google Scholar
16. Ash, KM, Cannon, JE, Biehl, D. Pneumocephalus following attempted epidural anesthesia. Can J Anaesth 1991;38:772–774.CrossRefGoogle Scholar