Acute onset headache complicating labor epidural caused by intrapartum pneumocephalus.
BACKGROUND
Epidural placement for obstetric anesthesia is a common procedure. Pneumocephalus, the introduction of air into the cranial cavity after epidural placement, is a rare complication encountered when air is used for identification of the epidural space.


METHODS
A 42-year-old primipara undergoing epidural placement reported sudden onset of severe headache with associated neurologic symptoms and nuchal rigidity. Emergent CT scan revealed pneumocephalus. With conservative management, her symptoms resolved with interval resumption of the air collection evidenced on interval CT.


CONCLUSIONS
Acute onset headache after epidural placement can present with impressive neurologic signs and symptoms. Prompt identification of the cause of this pathology is of vital importance to delineate pneumocephalus from potentially treatable or life-threatening disorders.
Smarkusky
Loren
L
Department of Obstetrics, Division of Maternal Fetal Medicine and Anesthesia, University of Miami School of Medicine/Jackson Memorial Hospital, Miami, FL 33101, USA.
DeCarvalho
Helena
H
Bermudez
Ady
A
González-Quintero
Víctor Hugo
VH
D000208:Acute Disease; D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006261:Headache / Q000209:etiology*; D006801:Humans; D007751:Labor, Induced; D007743:Labor, Obstetric; D016239:MEDLINE; D008297:Male; D016104:Oligohydramnios; D011007:Pneumocephalus / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D014057:Tomography, X-Ray Computed