Abstract
OBJECTIVE: Iatrogenic pneumocephalus following epidural anesthesia can present with acute severe debilitating headache. BACKGROUND: Postpartum headache can be a symptom of a potentially severe neurological disorder such as cerebral venous thrombosis, subarachnoid hemorrhage, eclampsia, or low pressure headache. Post epidural anesthesia pneumocephalus (PEAP) is a relatively rare cause of postpartum headache. The pattern of headache has not been well-described in the neurology literature. We describe three cases of PEAP and analyzed previously published cases to discern the characteristics of presenting headache as well as associated outcomes. DESIGN/METHODS: Case reports and literature search utilizing Pubmed between 1983-2014 were incorporated into the review. Three cases seen in our institute were included in the review. Abstracted data included: patient demographics, time and location of headache, treatment, and patient outcome. RESULTS: 23 cases with PEAP associated headache were reviewed. Age range of patients was 17-34 years old and indication for epidural anesthesia was obstetrical. Headache onset was immediately following epidural catheter insertion (n=18; 78[percnt]). Isolated headache was present in 20 (87[percnt]) patients. Headache with focal neurological deficits was present in 3 (13[percnt]) patients. Average length of stay was 2.9 days. Complete resolution and neurological recovery was seen in 21 patients (91[percnt]) within 3 days. Head computed tomography without contrast was the initial choice of imaging. Treatment was broad and included bed rest, oxygenation, analgesia, and epidural blood patch. CONCLUSIONS: The majority of PEAP cases reported have been associated with obstetrical delivery. Headache is typically present with severe intensity and rapid onset within few seconds following epidural anesthesia. Clinicians should include pneumocephalus in their differential of postpartum headache and have a low threshold to obtain a brain imaging study. Post epidural anesthesia pneumocephalus often requires simple treatment with oxygen, analgesia and bed rest.
Disclosure: Dr. Saada has nothing to disclose. Dr. mannel has nothing to disclose. Dr. Krishnaiengar has nothing to disclose.
Tuesday, April 21 2015, 2:00 pm-6:30 pm
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