A case of pneumocephalus during labor epidural analgesia: A case report

Son, Ju Hyung; Jee, Young Seok; Shin, Young Chul; Yoon, Hea Jo; Lee, In Ho; Jeon, Joo Yeon

Case Report

Obstetric Anesthesia

Anesthesia and Pain Medicine 2012;7(3):262-265.
Published online July 31, 2012.

A case of pneumocephalus during labor epidural analgesia: A case report

Ju Hyung Son, Young Seok Jee, Young Chul Shin, Hea Jo Yoon, In Ho Lee, Joo Yeon Jeon

Department of Anesthesiology and Pain Medicine, Cheil General Hospital and Women Healthcare Center, College of Medicine, Kwandong University, Seoul, Korea. jisaac@naver.com

Abstract

Pneumocephalus can be developed after a dural puncture, which occurs in association with epidural procedures. A 37-year-old, gestational age 40 weeks, pregnant woman was admitted for vaginal delivery. She asked for epidural analgesia when she suffers with labor pain. Epidural anesthesia was done at the L3-L4 interspace with the loss of resistance technique, using air. During the identification of the epidural space, an accidental dural puncture was diagnosed by observing a free flow of CSF, through the needle. The patient developed headache 2 hours later. She was treated with hydration, oxygen, analgesics and the autologus blood patch procedure was done, at the L4-L5 interspace. Despite these measures, the patient's symptoms worsened with nausea and vomiting. A brain CT scan showed the presence of pneumocephalus. After 100% oxygen therapy and metoclopramide injection, she was discharged on postpartum 2 days, without any complications.

Key Words: Autologus blood patch, Epidural anesthesia, Headache, Pneumocephalus