scholarly journals Pneumocephalus following labour epidural analgesia, a rare case report

2021 ◽  
Vol 4 (2) ◽  
pp. 066-068
Author(s):  
Rafiq Shagufta ◽  
Abbasher Ibrahim ◽  
Denona Branko ◽  
Anwar Sadia ◽  
Ahmad Ammara ◽  
...  

The lumbar epidural analgesia is commonly used for labour analgesia. The “loss of resistance to air” LORA technique is commonly used for recognition of epidural space. One of the rare complications of this technique is Pneumocephalus (PC). We want to present a case of Pneumocephalus which the mother developed during epidural analgesia in labour. The patient complained of severe headache immediately after attempt at epidural catheter insertion. The symptoms progressively worsened following delivery. A postnatal anaesthetic review was performed and an urgent CT scan of the brain was arranged that showed pneumocephalus. A conservative management pathway was followed with liberal analgesia, oxygen inhalation and keeping the patient mostly in supine position. Her symptoms regressed in severity over the next three days and subsided after one week. We believe that the amount of air used for LORA should be minimized; LORA should not be used after dural puncture and the use of normal saline would alleviate the risk.

2021 ◽  
pp. 4-5
Author(s):  
Om Prakash Singh ◽  
Vikas Kumar ◽  
Pushp Kant Tiwari

Sturge-Weber Syndrome (SWS) is one of the encephalotrigeminal angiomatosis and one of the important segmental vascular neurocutaneous disorders .The occurrence is not very uncommon and the prevalence is 1:20000 to 1:50000.(1) SWS occurs due to the presence of residual embryonic vessels . The various signs and symptoms include capillary malformation in the face a port wine birthmark and similar malformation in the brain involving leptomeniges as well as blood vessels of the eye causing glaucoma. The patient presents with seizures , hemiparesis and stroke like symptoms, headaches and developmental delay.(2) The imaging nding in SWS children is the calcication in the parietal and occipital area of the brain. The EEG ndings in SWS are the attenuation and the excess of slow activities.We are presenting here a rare case of , a fourteen year old male child who presented to our emergency department with status epilepticus. The aim of presenting this case is to share the classical presentation and the challenges involved in the management


2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Ashok Jadon ◽  
Surabhi Srivastawa ◽  
Neelam Sinha ◽  
Swastika Chakraborty ◽  
Apoorva Bakshi ◽  
...  

Abstract Background The dural puncture epidural (DPE) technique is relatively a new technique of labor analgesia and has been advocated with the advantage of faster onset of pain relief. However, there are differences of opinion regarding the efficacy of the DPE technique and the size of the spinal needle to be used for the DPE. Various studies have suggested that DPE can only be done with a larger gauge of a spinal needle; however, recent studies have variable observations. We have compared the conventional lumbar epidural analgesia and DPE using a 27G pencil-point needle to assess the efficacy of DPE and its possible side effects. Results The time to achieve a 50% reduction in VAS was 7.06 ± 0.79 min in group CLE (n = 15) and 5.0 ± 1.06 min in group DPE (n = 15) (difference of two means was 2.06, 95% CI [1.36, 2.75], t = 5.99, p < 0.0001). The time to achieve VAS < 3 in group CLE was 14.93 ± 1.98 min, and in the group DPE, it was 10.13 ± 1.45 min (difference of two means was 4.8, 95% CI [3.52, 6.09], t = 7.55, p < 0.0001). The mode of delivery, APGAR scores, and side effects were comparable (p > 0.05). Conclusions DPE provided faster relief of labor pain than the conventional labor epidural analgesia. There were no added side effects by DPE in conventional lumbar epidural analgesia for labor. A 27G Whitacre pencil-point needle can be used for DPE. Trial registration CTRI, CTRI/2020/08/027060. Registered on 10/08/2020. Trial registered prospectively. CTRI website URL: http://ctri.nic.in


2019 ◽  
Vol 7 (1) ◽  
pp. 52-53
Author(s):  
Gholamreza Mohseni ◽  
Faranak Behnaz ◽  
Zahra Tahmasebi

Lumbar epidural anesthesia commonly used to control post-operation pain. The ‘loss-ofresistance’ to air technique (LORA) generally engaged in the appreciation of the epidural space. One of the rare but serious side effects of this technique is pneumocephalus. We report a case of sudden frontal and parietal headache after a dural puncture during the performance of epidural analgesia using the LOR to air technique. Keywords: Epidural analgesia; ‘loss-of- resistance’ to air technique (LORA); Pneumocephalus; loss of consciousness; headache.


Author(s):  
W.J. Becker

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.Conclusion: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.


Cureus ◽  
2021 ◽  
Author(s):  
Gisha V Mathew ◽  
Khalil Shibli ◽  
Noureddine Korichi ◽  
Venkatesh B Thippeswamy

Author(s):  
Arash Azhideh ◽  
Farzad Ashrafi ◽  
Davood Ommi ◽  
Maryam Yousefi-Asl ◽  
Mehran Arab-Ahmadi

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.


2021 ◽  
Vol 11 (Number 2) ◽  
pp. 68-71
Author(s):  
Tahmina Siddika ◽  
Ashraful Hasib ◽  
Avijith Bhattacharjee ◽  
Naziur Rahman ◽  
M H Khan Pavel ◽  
...  

Vertebral and basilar arteries are the major blood suppliers of the brain. They supply nearly one-third of the brain. Congenital absence of these arteries is a rare condition. Usually, this condition presents with stroke like presentation. This is a case presentation of a 40-year-old lady who was diagnosed as congenital agenesis of vertebra-basilar arteries. This lady was presented with intraventricular hemorrhage. Subsequently the diagnosis was made by cerebral angiogram.


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