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Pneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological Presentation

2017-02Journal article Open access
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dc.contributor.authorFigueira, H.
dc.contributor.authorGuimaraes, J.
dc.contributor.authorSousa, A.
dc.contributor.authorRegalado, A.
dc.date.accessioned2017-08-29T11:42:27Z
dc.date.available2017-08-29T11:42:27Z
dc.date.issued2017-02
dc.description.abstractPneumocephalus is a rare consequence of epidural anesthesia, which may occur following inadvertent or unidentified dural puncture when the loss of resistance to air technique is applied to identify the epidural space. Headache is the most common symptom presented in this condition, usually with sudden onset. This case report describes an unusual presentation of diffuse pneumocephalus after an unidentified dural puncture. The patient (male, 67 years old) was submitted to epidural catheter placement for the treatment of acute exacerbation of ischemic chronic pain using loss of resistance to air technique. No cerebrospinal fluid or blood flashback was observed after needle withdrawal. Shortly after the intervention, the patient presented symptoms of lethargy, apathy, and hypophonia, which are not commonly associated with pneumocephalus. No motor or sensory deficits were detected. Cranial computed tomography showed air in the frontal horn of the left ventricle, subarachnoid space at interhemispheric fissure and basal cisterns, confirming the diagnosis of diffuse pneumocephalus. The patient remained under vigilance with oxygen therapy and the epidural catheter left in place. After 24 hours, cranial computed tomography showed air in the temporal and frontal horns of the left ventricle, with no air in the subarachnoid space. The patient presented no neurological signs or symptoms at this time. Although headache is the most common symptom presented in reported cases of pneumocephalus, this case shows the need for the clinician to be aware of other signs and symptoms that may be indicative of this condition, in order to properly diagnose and treat these patients.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationPain Physician. 2017 Feb;20(2):E329-E334pt_PT
dc.identifier.issn2150-1149
dc.identifier.urihttp://hdl.handle.net/10400.16/2169
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherAmerican Society of Interventional Pain Physicianspt_PT
dc.relation.publisherversionhttp://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=20&page=E329pt_PT
dc.subjectPneumocephaluspt_PT
dc.subjectcontinuous epidural analgesiapt_PT
dc.subjectischemic chronic painpt_PT
dc.subjectloss-of-resistance to air techniquept_PT
dc.subjectdural puncturept_PT
dc.subjectheadachept_PT
dc.subjectunusual presentationpt_PT
dc.titlePneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological Presentationpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceUnited States of Americapt_PT
oaire.citation.endPageE334pt_PT
oaire.citation.issue2pt_PT
oaire.citation.startPageE329pt_PT
oaire.citation.titlePain Physicianpt_PT
oaire.citation.volume20pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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