Pneumocephalus and Seizure in Patient after Epidural Lumbar Puncture: Case Report

  • Arash Azhideh ORCID Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Farzad Ashrafi ORCID Mail Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Davood Ommi ORCID Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Maryam Yousefi-Asl ORCID Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Mehran Arab-Ahmadi ORCID Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Keywords:
Seizure, Pneumocephalus, Lumbar puncture

Abstract

Lumbar epidural analgesia is using widely as an alternative method for anesthesia. Although it has its benefits such as the low risk of complications in contrast with general anesthesia, also it has some adverse effects, for instance: headache, loss of consciousness, pneumocephalus, dizziness, and seizure. Pneumocephalus is a rare complication of lumbar epidural block.
In this case of study, a patient represents stenosis in the site of anastomosis of colon and duodenum candidate for a repair surgery with the lumbar epidural block. Epidural catheter insertion was done in the sitting position; local anesthesia was administered at the 4th and 5th lumbar vertebral interspace. A 17-gauge Husted needle was inserted using the loss-of-resistance (LOR) by air technique. Immediately the patient complained of headaches and then deteriorated to a tonic-clonic movement accompanied by post-seizure sleep, which ended up in termination of the procedure. The first-day CT-scan revealed multiple pneumocephalus. Supporting treatment was administered for 10 days; another CT-scan taken from the patient demonstrated improvement and the patient was discharged without any neurological deficit.
Regional analgesia should be administered if possible under the superintendence of an expert, however, complications of an epidural catheter, such as accidental dural puncture, can postpone the recovery of the patient.

References

[1] Hawley JS, Ney JP, Swanberg MM. Subarachnoid pneumocephalus from epidural steroid injection. Headache. 2005; 45(3):24-8.
[2] Van den Berg AA, Nguyen L, von-Maszewski M, Hoefer H. Unexplained fitting in patients with post-dural puncture headache. Risk of iatrogenic pneumocephalus with air rationalizes use of loss of resistance to saline. Br J Anaesth. 2003; 90(6):810-1; author reply 811-2.
[3] Avellanal M, Olmedilla L, Ojea R, Rueda ML, Navia J. Pneumocephalus after spinal anesthesia. Anesthesiology. 1996; 85:423-425.
[4] Kasai K, Osawa M. Pneumocephalus during continuous epidural block. J Anesth. 2007; 21(1):59-61.
[5] Ferrante E, Rubino F, Porrinis L. Pneumocephalus: A Rare Complication of Epidural Catheter Placement During Epidural Blood Patch. Headache. 2014; 54(3):539-40.
[6] Sharma M, Mehta Y, Sawhney R, Vats M, Trehan N. Thoracic epidural analgesia in an obese patient with body mass index more than 30kg/m2 for off pump coronary artery bypass surgery. Ann Card Anaesth. 2010; 13(1):28-33.
[7] Mehta Y, Manikappa S, Juneja R, Trehan N. Obstructive sleep apnea syndrome: anesthetic implications in the cardiac surgical patient. J Cardiothorac. Vasc Anesth. 2000; 14(4):449-53.
[8] Maleki Delarestaghi M, Ahmadi A, Dehghani Firouzabadi F, Roomiani M, Dehghani Firouzabadi M, Faham Z. Effect of Low-Pressure Drainage Suction on Pharyngocutaneous Fistula After Total Laryngectomy. Ann Otol Rhinol Laryngol. 2020; 0003489420934506.
[9] Gómez-Ríos MÁ, Fernández-Goti MC. Pneumocephalus after Inadvertent Dural Puncture during Epidural Anesthesia. Anesthesiology. 2013; 118(2):444.
[10] Rodrigo P, Garcia JM, Ailagas J. General convulsive crisis related to pneumocephalus after inadvertant dural puncture in an obstetric patient. Rev Esp Anestesiol Reanim. 1997; 44(6):247-249.
[11] Lin HY, Wu HS, Peng TH, Yeh YJ, Cheng IC, Lin IS, Liu CH. Pneumocephalus and respiratory depression after accidental dural puncture during epidural analgesia--a case report. Acta Anaesthesiol Sin. 1997; 35(2):119-23.
Published
2020-08-18
How to Cite
1.
Azhideh A, Ashrafi F, Ommi D, Yousefi-Asl M, Arab-Ahmadi M. Pneumocephalus and Seizure in Patient after Epidural Lumbar Puncture: Case Report. Arch Anesth & Crit Care. 6(3):139-41.
Section
Case Report(s)