Pneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological Presentation
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.16/2169 |
Resumo: | Pneumocephalus is a rare consequence of epidural anesthesia, which may occur following inadvertent or unidentified dural puncture when the loss of resistance to air technique is applied to identify the epidural space. Headache is the most common symptom presented in this condition, usually with sudden onset. This case report describes an unusual presentation of diffuse pneumocephalus after an unidentified dural puncture. The patient (male, 67 years old) was submitted to epidural catheter placement for the treatment of acute exacerbation of ischemic chronic pain using loss of resistance to air technique. No cerebrospinal fluid or blood flashback was observed after needle withdrawal. Shortly after the intervention, the patient presented symptoms of lethargy, apathy, and hypophonia, which are not commonly associated with pneumocephalus. No motor or sensory deficits were detected. Cranial computed tomography showed air in the frontal horn of the left ventricle, subarachnoid space at interhemispheric fissure and basal cisterns, confirming the diagnosis of diffuse pneumocephalus. The patient remained under vigilance with oxygen therapy and the epidural catheter left in place. After 24 hours, cranial computed tomography showed air in the temporal and frontal horns of the left ventricle, with no air in the subarachnoid space. The patient presented no neurological signs or symptoms at this time. Although headache is the most common symptom presented in reported cases of pneumocephalus, this case shows the need for the clinician to be aware of other signs and symptoms that may be indicative of this condition, in order to properly diagnose and treat these patients. |
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Pneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological PresentationPneumocephaluscontinuous epidural analgesiaischemic chronic painloss-of-resistance to air techniquedural punctureheadacheunusual presentationPneumocephalus is a rare consequence of epidural anesthesia, which may occur following inadvertent or unidentified dural puncture when the loss of resistance to air technique is applied to identify the epidural space. Headache is the most common symptom presented in this condition, usually with sudden onset. This case report describes an unusual presentation of diffuse pneumocephalus after an unidentified dural puncture. The patient (male, 67 years old) was submitted to epidural catheter placement for the treatment of acute exacerbation of ischemic chronic pain using loss of resistance to air technique. No cerebrospinal fluid or blood flashback was observed after needle withdrawal. Shortly after the intervention, the patient presented symptoms of lethargy, apathy, and hypophonia, which are not commonly associated with pneumocephalus. No motor or sensory deficits were detected. Cranial computed tomography showed air in the frontal horn of the left ventricle, subarachnoid space at interhemispheric fissure and basal cisterns, confirming the diagnosis of diffuse pneumocephalus. The patient remained under vigilance with oxygen therapy and the epidural catheter left in place. After 24 hours, cranial computed tomography showed air in the temporal and frontal horns of the left ventricle, with no air in the subarachnoid space. The patient presented no neurological signs or symptoms at this time. Although headache is the most common symptom presented in reported cases of pneumocephalus, this case shows the need for the clinician to be aware of other signs and symptoms that may be indicative of this condition, in order to properly diagnose and treat these patients.American Society of Interventional Pain PhysiciansRepositório Científico do Centro Hospitalar Universitário de Santo AntónioFigueira, H.Guimaraes, J.Sousa, A.Regalado, A.2017-08-29T11:42:27Z2017-022017-02-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.16/2169engPain Physician. 2017 Feb;20(2):E329-E3342150-1149info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-10-20T10:59:23Zoai:repositorio.chporto.pt:10400.16/2169Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:38:24.709273Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Pneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological Presentation |
title |
Pneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological Presentation |
spellingShingle |
Pneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological Presentation Figueira, H. Pneumocephalus continuous epidural analgesia ischemic chronic pain loss-of-resistance to air technique dural puncture headache unusual presentation |
title_short |
Pneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological Presentation |
title_full |
Pneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological Presentation |
title_fullStr |
Pneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological Presentation |
title_full_unstemmed |
Pneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological Presentation |
title_sort |
Pneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological Presentation |
author |
Figueira, H. |
author_facet |
Figueira, H. Guimaraes, J. Sousa, A. Regalado, A. |
author_role |
author |
author2 |
Guimaraes, J. Sousa, A. Regalado, A. |
author2_role |
author author author |
dc.contributor.none.fl_str_mv |
Repositório Científico do Centro Hospitalar Universitário de Santo António |
dc.contributor.author.fl_str_mv |
Figueira, H. Guimaraes, J. Sousa, A. Regalado, A. |
dc.subject.por.fl_str_mv |
Pneumocephalus continuous epidural analgesia ischemic chronic pain loss-of-resistance to air technique dural puncture headache unusual presentation |
topic |
Pneumocephalus continuous epidural analgesia ischemic chronic pain loss-of-resistance to air technique dural puncture headache unusual presentation |
description |
Pneumocephalus is a rare consequence of epidural anesthesia, which may occur following inadvertent or unidentified dural puncture when the loss of resistance to air technique is applied to identify the epidural space. Headache is the most common symptom presented in this condition, usually with sudden onset. This case report describes an unusual presentation of diffuse pneumocephalus after an unidentified dural puncture. The patient (male, 67 years old) was submitted to epidural catheter placement for the treatment of acute exacerbation of ischemic chronic pain using loss of resistance to air technique. No cerebrospinal fluid or blood flashback was observed after needle withdrawal. Shortly after the intervention, the patient presented symptoms of lethargy, apathy, and hypophonia, which are not commonly associated with pneumocephalus. No motor or sensory deficits were detected. Cranial computed tomography showed air in the frontal horn of the left ventricle, subarachnoid space at interhemispheric fissure and basal cisterns, confirming the diagnosis of diffuse pneumocephalus. The patient remained under vigilance with oxygen therapy and the epidural catheter left in place. After 24 hours, cranial computed tomography showed air in the temporal and frontal horns of the left ventricle, with no air in the subarachnoid space. The patient presented no neurological signs or symptoms at this time. Although headache is the most common symptom presented in reported cases of pneumocephalus, this case shows the need for the clinician to be aware of other signs and symptoms that may be indicative of this condition, in order to properly diagnose and treat these patients. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-08-29T11:42:27Z 2017-02 2017-02-01T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.16/2169 |
url |
http://hdl.handle.net/10400.16/2169 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Pain Physician. 2017 Feb;20(2):E329-E334 2150-1149 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
American Society of Interventional Pain Physicians |
publisher.none.fl_str_mv |
American Society of Interventional Pain Physicians |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
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1799133645627195392 |