title: Pneumocephalus during cervical transforaminal epidural steroid injections: a case report.
abstract: A cervical transforaminal epidural injection of anesthetic and corticosteroids (CTFESI) is a frequently used procedure for cervical radiculopathy. Most cases of pneumocephalus after an epidural block occur when using an interlaminar approach with the loss-of-resistance technique. The authors present the first case of pneumocephalus after cervical transforaminal epidural injection of anesthetic and corticosteroids. A 64-yr-old woman with left C7 radiculopathy was undergoing C6-7 transforaminal epidural injection of anesthetic and corticosteroids. The epidural spread of contrast was checked by fluoroscope, and 5 mg of dexamethasone in 4 ml of 0.1875% ropivacaine was injected. She lost consciousness 5 mins after the procedure and regained awareness after manual ventilation. She subsequently complained of nausea and headache, and a computed tomography brain scan revealed pneumocephalus. After carefully assessing the fluoroscopic images, the authors believe that the needle may have punctured the dura mater of the nerve root sleeve, allowing air to enter the subdural space. Thus, fluoroscopic images should be carefully examined to reduce dural puncture when performing cervical transforaminal epidural injection of anesthetic and corticosteroids, and air should be completely removed from the needle, extension tube, and syringe.
authors.affiliation: From the Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea (WJK, HGP, YHP, GHK, HYS); and the Departments of Prosthodontics and Dentistry, Dongtan Sacred Heart Hospital, Graduate School of Clinical Dentistry, Hallym University, Seoul, Korea (MRS).
authors.forename: Won-Joong
authors.initials: WJ
authors.lastname: Kim
authors.forename: Hae-Gyun
authors.initials: HG
authors.lastname: Park
authors.forename: Yong-Hee
authors.initials: YH
authors.lastname: Park
authors.forename: Mee-Ran
authors.initials: MR
authors.lastname: Shin
authors.forename: Gill-Hoi
authors.initials: GH
authors.lastname: Koo
authors.forename: Hwa-Yong
authors.initials: HY
authors.lastname: Shin
mesh_terms: D000577:Amides / Q000008:administration & dosage; D002574:Cervical Vertebrae; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects*; D008875:Middle Aged; D011007:Pneumocephalus / Q000175:diagnosis* / Q000209:etiology*; D011843:Radiculopathy / Q000188:drug therapy*; D000077212:Ropivacaine
chemical_list: D000577:Amides; D005938:Glucocorticoids; D000077212:Ropivacaine; D003907:Dexamethasone