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Pneumocephalus as a cause for headache.
1University of Calgary and Calgary Health Region, Calgary, Alberta, Canada.
Summary
Pneumocephalus, or intracranial air, can cause severe headaches after epidural procedures. Air can enter the subarachnoid space through prior dural punctures, especially during epidural blood patch.
Area of Science:
- Neurology
- Neurosurgery
- Anesthesiology
Background:
- Pneumocephalus, the presence of air within the cranial cavity, can manifest as a severe headache.
- This condition is often overlooked in certain clinical scenarios, delaying diagnosis and treatment.
Observation:
- A case study involving a 35-year-old woman who developed an abrupt, severe headache during an epidural blood patch procedure.
- Brain CT scan revealed intracranial air in the subarachnoid space, despite no apparent dural puncture during the procedure.
Findings:
- Literature review and patient experience suggest that air introduced into the epidural space can migrate to the subarachnoid space.
- This migration is facilitated by pre-existing dural puncture sites, commonly from prior lumbar punctures.
Implications:
- Pneumocephalus should be considered in the differential diagnosis of severe headaches associated with epidural procedures.
- High concentrations of inspired oxygen can accelerate the resolution of intracranial air collections.