Pneumocephalus after an epidural anesthetic block

Abstract

Introduction: pneumocephalus is an unusual and multicausal entity, which is characterized
by the presence of intracranial air; the clinical manifestations depend on its mechanism of
presentation. To make the diagnosis, it requires integrating clinical and imaging aspects;
treatment can be conservative or surgical and the prognosis depends on early diagnosis and
timely management. Case description: the case of a 25-year-old woman with a history of
spontaneous labor that was managed with epidural anesthetic block analgesia is presented.
She subsequently manifested headache associated with phonophobia, nausea and emesis. A
computed axial tomography was performed, which showed an image with characteristics of
scarce pneumoventricle at the level of the frontal horn of the right ventricle. Conservative
treatment was given and the patient had a satisfactory evolution. Conclusion: this is one of
the few case reports of pneumocephalus after epidural anesthetic block, which is a rare
complication of the procedure. The characteristic clinical manifestation is headache that
begins in a time interval close to the placement of the medication; the reference test that
confirms the diagnosis is simple computed axial tomography of the skull. Management can
be conservative or surgical depending on the mechanism of presentation of the
pneumocephalus; the prognosis is generally good, however, in tension pneumocephalus it
depends on early diagnosis and timely surgical management.