Pneumocephalus after Epidural Block

Abstract

Introduction: Pneumocephalus is a complication following neuroaxial anesthesia. Its occurrence mechanism consists in a direct injection of air into the subdural space after inadvertent dura mater puncture. It is characterized by headache and neurological signs of space occupation, such as cranial nerve palsies, paresis, neurological deficits, as well as signs of increased endocranial pressure such as vomiting, dizziness, lethargy and seizures.

Objective: To describe the clinical signs, complementary studies, behavior and evolution of a patient with pneumocephalus as a complication of therapeutic epidural block.

Case presentation: A 57-year-old patient started to present, after an epidural block, convulsions, decreased consciousness, psychomotor agitation, nausea and vomiting; requiring mechanical ventilation. The patient evolved satisfactorily until being clinically discharged.

Conclusions: The presented case exhibited nonspecific neurological manifestations; the sudden onset after the invasive procedure initially led to suspect systemic toxicity by local anesthetics. However, due to the acute neurological event, a computed tomography scan was performed, showing the presence of a pneumocephalus. Conservative management of the pneumocephalus was an effective therapeutic approach and resulted in a satisfactory evolution of the patient.