Hospital: Hospital Universitario Virgen Macarena.
Ciudad:
Nº:
Aut@r o Autores: R.S. Estelles López, X.M. Cortés Sañudo, I. Avilés Vázquez, M.P. García Rodríguez, C. Pérez Ramírez, T. Busquier Cerdán.,
Presentación:
A 26 year female presented to Emergency Department with occipital and frontal headache parcial responsive to analgesics. The headache started developing after a few hours she was given an epidural anesthesia for labour pain wich was four days prior and that has progressively increased. She had photophobia, sonophobia and nausea, not fever. Pain increases with upright position. Vital signs and neurological examination were normal. Blood test showed anemia and no other remarkable findings. CT scan head revealed gas intracranial in right frontal region, basal cisterns and intraventricular compatible with pneumencephalus. The patient was treated conservatively with analgesic and recommendation of follow-up.
Discusión:
Pneumencephalus is defined as the presence of intracranial gas. Demographics depend on the cause. In most cases it is usually asymptomatic. The headache is one of the symptoms. Its etiology may be of traumatic , by instrumentation as in our case or infectious. Epidural injections are commonly used in pain management and obstetrics, pneumocephalus being a rare complication that is described in only a few cases of this kind of anesthesia. Other complications of this technique include hemorrhage, brain fluid leak, and infection. It can be located extracerebral, intracerebral or intravascular. Its size is variable, it may adopt a focal or diffuse morphology. The best diagnostic test is the CT without contrast, shown gas that must have a very low density (- 1000 UH). In the magnetic resonance shows focuses of absent signal in all the sequences. Treatment depends on the cause, which usually resolves itself once the etiology is solved. In cases of tension pneumocephalus, craniotomy may be required.
Conclusión:
Pneumencephalus is defined as the presence of intracranial gas. Demographics depend on the cause. In most cases it is usually asymptomatic. The headache is one of the symptoms. Its etiology may be of traumatic , by instrumentation as in our case or infectious. Epidural injections are commonly used in pain management and obstetrics, pneumocephalus being a rare complication that is described in only a few cases of this kind of anesthesia. Other complications of this technique include hemorrhage, brain fluid leak, and infection. It can be located extracerebral, intracerebral or intravascular. Its size is variable, it may adopt a focal or diffuse morphology. The best diagnostic test is the CT without contrast, shown gas that must have a very low density (- 1000 UH). In the magnetic resonance shows focuses of absent signal in all the sequences. Treatment depends on the cause, which usually resolves itself once the etiology is solved. In cases of tension pneumocephalus, craniotomy may be required.
Bibliografía:
– Chacko J, Levis K, Hahn B. Pneumocephalus after Epidural Injection. The Journal of Emergency Medicine. 2018,54(3):e45-e47. – Nistal-Nuño B, Gómez-Ríos M. Case Report: Pneumocephalus after labor epidural anesthesia. F1000Research.