Dural puncture and iatrogenic pneumocephalus with subsequent transverse myelitis in a parturient

Acute Transverse Myelitis in Pregnancy: The Use of ProSeal Laryngeal Mask Airway Without Curarization for Emergency Cesarean Section

Transverse myelitis is a rare inflammatory neurological disorder of the spinal cord that damages the myelin covering the spinal cord and thus produces sensory, motor, and autonomic symptoms. A 26-year-old primigravida of 40 weeks gestation presented to the obstetric emergency of our hospital with complaints of weakness in both lower limbs and inability to walk for four days. A diagnosis of acute transverse myelitis was made, and due to fetal distress and arrest of labor in the second stage, an emergency cesarean section was planned. Considering the risks associated with the neuraxial technique and muscle relaxants, cesarean section was planned under general anesthesia and was successfully done with ProSeal laryngeal mask airway (LMA) using propofol and sevoflurane without muscle relaxant.

Pneumocephalus after lumbar epidural steroid injection: a case report and review of the literature

Pneumocephalus may occur after inadvertent injection of air into the subarachnoid space while performing epidural anesthesia using a loss-of-resistance technique with air in the syringe. We report a case of pneumocephalus after an interlaminar epidural steroid injection using the loss-of-resistance to air technique. In this report, we examine the etiology, the expected course of symptoms, and resolution, as well as treatment, of pneumocephalus following a systematic literature review.

Pneumocephalus in patients with orthostatic headache

Cerebrospinal fluid (CSF) leak or shunt overdrainage is a well-known cause of orthostatic headaches and low CSF pressures. We report two cases of orthostatic headache with pneumocephalus on brain imaging. The orthostatic headache developed after drainage of spinal operation site and epidural block. Brain MRI revealed characteristic findings of CSF hypovolemia including pachymeningeal enhancement and mild subdural fluid collections. Air was also observed in the ventricular or subarachnoid space in both patients, which might enter the subarachnoid or ventricular space during a procedure via the pressure gradient or an injection.

Pneumocephalus as a cause for headache

BACKGROUND

Pneumocephalus can be a cause of headache, but is easily overlooked in some clinical circumstances.

CASE STUDY

A 35-year-old woman developed severe headache of abrupt onset during an epidural blood patch procedure done for a post-lumbar puncture headache. A brain CT scan showed subarachnoid air even though there was no evidence of a dural puncture having occurred during the procedure.

RESULTS

The experience of our patient, and a review of the literature suggests that air injected into the epidural space during use of the "loss of resistance" technique can enter the subarachnoid space if a dural puncture site from a previous lumbar puncture is present.

CONCLUSIONS

Pneumocephalus should be considered as a potential cause for a severe headache occurring in association with epidural procedures, and also in a number of other clinical settings. Use of a high inspired air oxygen concentration can hasten absorption of an intracranial air collection.

[Pneumocephalus after spinal anesthesia]

We report the case of a 76-year-old man who received a spinal anaesthesia for inguinal hernia repair surgery. A cranial CT scan which was performed because the patient complained of postoperative headache and hemiparesis showed an important pneumocephalus. Because postoperative questioning revealed that the patient had a chronic and neglected rhinorrhea, we hypothesise that this pneumocephalus was secondary to an old unknown osteodural leak with intracranial air entry secondary to the spinal anaesthesia-releated decrease in CSF pressure.

Subdural air collection: a likely source of radicular pain after lumbar epidural

This case conference reports two cases of epidural anesthesia in which air was used to identify the epidural space during a loss-of-resistance placement technique. Both patients subsequently complained of severe pain and subdural air was demonstrated in case 1 by computed tomography and in case 2 by magnetic resonance imaging. The possible causes of the pain syndrome experienced by both patients are discussed.