Abstract
Iatrogenic pneumocephalus and dural puncture are some causes of headache following cervical epidural injection. A 50-year-old woman presented with a sharp headache at the base of her skull following a cervical epidural injection for chronic neck pain. It was not relieved by lying down and was associated with nausea, vomiting, and photophobia without fever or neck rigidity. Neurological examination failed to show any abnormalities. A head CT scan showed newly evident pneumocephalus in the ventricular system and the extra-axial subarachnoid space within the sulci of the right frontal lobe. Oxygen supplementation was started with the help of a non-rebreather mask connected to 15 liters of oxygen and was slowly down titrated to room air. Repeat CT scan of the head after 48 hours showed complete resolution of the intracranial pneumocephalus. Normobaric oxygen therapy via a non-rebreather mask and a high-flow nasal cannula is effective for the treatment of intracranial pneumocephalus.
Highlights
Cervical epidural injection of anesthetics and/or steroids is a commonly used procedure for cervical radiculopathy and/or pain [1]
We present a rare case of pneumocephalus following cervical epidural injection, which was successfully managed with oxygen therapy
Pneumocephalus is similar to postdural puncture headache in the sense that it is aggravated by any motion
Summary
Cervical epidural injection of anesthetics and/or steroids is a commonly used procedure for cervical radiculopathy and/or pain [1]. A 50-year-old woman with a medical history of chronic neck and back pain secondary to a motor vehicle accident (MVA) in 2016, who had been receiving outpatient epidural injections for pain control, presented to the emergency room with complaints of severe headache. She reported that she had a cervical epidural injection roughly 30-45 minutes prior to this event. A repeat CT scan of the head was done after 48 hours, which showed complete resolution of the intracranial pneumocephalus (Figure 3) Her headache gradually improved and oxygen supplementation was discontinued
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