Millions of people around the world suffer from neurological injuries that can be the cause for serious concern. In some instances, millions ignore the injuries and the warning signs associated with head traumas. Head traumas are a serious injury that have side effects that can range from headaches, dizziness, and other conditions that are best checked in case of damage to the brain or the spinal cord. Pneumocephalus is a condition that can be complicated to diagnose. When patients go in to get checked out the most common complaint is headaches that tend to be neurological symptoms that are related to the buildup of air that places pressure on the brain. Only in the case of MRI scan can doctors determine if there is a serious neurological problem that will show images of the brain and skull. Pneumocephalus is an emergency situation in which there is no outlet for the air that has buildup in the skull. Pnemocephalus is present within the intracranial compartments of the cranial vault that can cause serious complications including the disruption of the brain.
Pnemocephalus is associated with facial and head traumas, tumors at the skull base, results from otorhinolaryngological and neurosurgery procedures and can rarely occur spontaneously in individuals. In surgeries is where the condition most often occurs that can be contributed from duration of the surgery, the head position, the addition of anesthesia using nitrous oxide in spinal, and epidurals, the CSF (cerebrospinal fluid) drainage from lumbar drains, intraoperative osmotheraphy, and other contributing factors. In some instances and more commonly besides head trauma, scuba diving cases are linked to pnemoccephalus due the pressure of oxygen and water associated with the activity. Presented in this presentation is the case report of a patient who received an epidural line during her labor. As a consequence, she experienced nausea and headaches shortly, these case report examines and analyzes her case and a discussion of pnemocephalus causes, diagnosis, and treatments.
Contributing factors to pnemocephalus vary with most occurring during surgical procedures, the most common are head traumas and the use of anesthesia administered. In the case of the female postpartum patient that initially complained of severe headaches, it was determined from complications associated with the epidural line administered during labor. Shortly after administering the epidural line the patient developed severe headaches and nausea that was determined to be from post lumbar puncture where she was given Percocet and ibuprofen. After discharging the severity of the headaches grew, she experienced pain in her bifrontal, holocranial, and associated with orthostatic pressure-like quality. After administering a cocktail of injections with no results the doctors performed a brain CT scan that showed air within the frontal horns of both lateral ventricles, greater on the left. The development of the air is determined from the epidural line. The results of pnemocelphalus in the patient could have occurred from, the air technique that air more easily allows detection of cerebrospinal fluid (CSF) leaking from the epidural needle after inadvertent dural puncture complicated from the use of a `dipstick’ for testing emitting fluid for pH and protein discussed by Van den Berg, L. Nguyen Von-Maszewski, H. Hoefer. (Van den Berg, Nguyen, Von-Maszewski, Hoefer, 2013) The CSF leakage is closely associated with orthostatic headaches as documented in the case report, “Pneumocephalus in Patients with Orthostatic Headache,” that followed to cases where the patients complained of severe headaches that occurred from the buildup of negative pressure from the result of dural arachnoid tear from the CSF application. In the second case, the result from the resistance of the needle advancement resulted from the injection of air to perform the epidural block. (Yoon, Sei Oh, Lee, Lee, Chun, Yu, 2008) In both cases, the use of CT scan was pertinent in diagnosing pnemocelphalus as well as emergency dural plasty and the lying in the supine position.
Epidural lines are rare that pnemocelphalus occurs however, complications associated with each procedures can developed effects in patients that doctors must note as a matter of concern. The team of Yen Dong Kim, Jae Hun Lee, and Yong Kwan Cheong developed a case study in which the patient experienced complications from pnemocephalus. The patient initially came in to receive treatment on his herpes condition located on his scalp. Complications occurred doing the removal of the procedure that led to the application of the lumbar epidural block. “Pneumocephalus in a Patient with No Cerebrospinal Fluid Leakage after Lumbar Epidural Block,” the patient received a lumbar epidural block after 35 minutes, the patient developed apnea and fell into unconsciousness. The doctors performed brain CT scan and diagnosed pneumocephalus. The doctors determined that when patients have complications, “one that occurs after epidural block is usually caused by the dural puncture performed during the epidural block while applying the loss of resistance technique using air.” (Kim, Lee, Cheong, 2012) There are several reasons of how the patient developed the condition that could have occurred due to the lumbar epidural block, however, they drew the conclusion of the air the came into the subdural space and flowed into the subarachnoid through the areas made weak from the dura. (Kim, Lee, Cheong, 2012)
Treatment options for pneumocephalus vary. In some cases, the condition resolves on its own with monitoring from doctors, other regress on their own, or laying in supine position (headaches). In other patients the use of surgical procedures in essential in releasing the air in the skull. Other patients may be treated with bed rest on their backs and inhalation oxygen, however surgery is important in most cases.
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Unexplained Fitting in Patients with Post-dural Puncture Headache. Risk of Iatrogenic Pneumocephalus with Air Rationalizes Use of Loss of Resistance to Saline. Van Den Berg AA, Nguyen L, Von-Maszewski M, Hoefer H.Br J Anaesth. 2003 Jun; 90(6):810-1; Author Reply 811-2.