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Pneumocephalus and Chemical Meningitis after Inadvertent Dural Puncture during Lumbar Epidural Injection
1Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, Korea.
Korean Journal of Neurotrauma
|May 13, 2020
Summary
Inadvertent dural puncture during lumbar epidural steroid injections can lead to simultaneous pneumocephalus and chemical meningitis. This case highlights the importance of minimizing dural puncture risks during such procedures.
Area of Science:
- Neurology
- Neurosurgery
- Pain Management
Background:
- Lumbar epidural steroid injections (ESIs) are common procedures for managing spinal pain.
- Inadvertent dural puncture (IDP) is a known complication of lumbar ESIs, potentially leading to cerebrospinal fluid leakage.
- Complications of IDP can include post-dural puncture headache, but simultaneous pneumocephalus and meningitis are rare.
Observation:
- A 60-year-old woman developed thunderclap headache and fever hours after a lumbar interlaminar ESI.
- Brain CT revealed pneumocephalus (air in the brain) following the procedure.
- Cerebrospinal fluid analysis indicated aseptic (chemical) meningitis, not bacterial.
Findings:
- The patient's pneumocephalus resolved spontaneously.
- Symptoms of chemical meningitis improved with conservative, symptomatic treatment.
- Cultures of cerebrospinal fluid remained negative for bacterial, mycobacterial, and fungal growth.
Implications:
- This case demonstrates that IDP during lumbar ESIs can concurrently cause pneumocephalus and chemical meningitis.
- Awareness of this dual complication is crucial for timely diagnosis and management.
- Strategies to minimize the risk of IDP during lumbar ESIs should be emphasized to prevent serious neurological sequelae.
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