| Subarachnoid and Subdural-Extraarachnoid Pneumocephalus in the Patient with No CSF LeaKage during Epidural Catheterization. |
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Hyun Joo Ahn, Woo SeoK Sim, Gaab Soo Kim, Youn Jung Kang, Yong chul Kim |
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Pain Management Center of Samsung Medical Center, SungKyunKwan University School of Medicine, Seoul, Korea. mallang@hanmir.com |
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| Abstract |
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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. |
| Key Words:
Anesthetic techniques: epidural; loss of resistance technique; Complications: pneumocephalus |
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