Cases reported "Pneumocephalus"

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1/14. pneumocephalus following inadvertent intrathecal puncture during epidural anesthesia: a case report and review of the literature.

    Regional anesthesia techniques (epidural and spinal) are preferred anesthetic modalities in modern obstetrics, in that both of these modalities enable maternal participation in the delivery process and assist in avoiding maternal aspiration associated with general anesthesia. We report an unusual and potentially severe complication of epidural anesthesia for elective repeat cesarean delivery. Following intravenous hydration and lateral uterine displacement, uneventful epidural anesthesia was administered. Toward the end of the otherwise uneventful cesarean the patient, who had been completely stable, became unresponsive, with dilated pupils that did not respond to light. The patient was immediately intubated and gradually regained consciousness and was extubated within 1 h. Cranial computed tomography disclosed pneumocephalus. Inadvertent pneumocephalus is reviewed.
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2/14. Dural puncture and iatrogenic pneumocephalus with subsequent transverse myelitis in a parturient.

    PURPOSE: To report a case of transverse myelitis following inadvertent dural puncture and iatrogenic pneumocephalus and any possible causal relationship is explored. CLINICAL FEATURES: A 32-yr-old primigravida developed a severe headache associated with pneumocephalus following accidental dural puncture when the loss of resistance to air technique was used to locate the epidural space. She was treated with oxygen 100% to promote resorption of the air and the headache resolved. One month later she developed a sensory disturbance in her feet. Neurological examination revealed reduced sensation to cold and pain to ankle level and bilateral suppressed knee and ankle reflexes but was otherwise normal. A spinal cord lesion (epidural abscess/hematoma) was excluded with an emergency T1 and T2 weighted magnetic resonance imaging (MRI) scan of the lumbar spine. Over the next 48 hr the sensory disturbance worsened to involve her legs and waist. Examination revealed a sensory loss to waist level, reduced joint position sense and vibration sense in her lower limbs and absent knee and ankle reflexes bilaterally, but normal power in both her legs. A further full length T2 weighted MRI scan of the spine showed a small area of high signal at the level of T3 compatible with transverse myelitis. This was treated with high dose corticosteroids and her symptoms resolved over the next three months. CONCLUSION: The etiology of transverse myelitis after dural puncture in a parturient could not be identified nor could any causal link be established between the dural puncture, pneumocephalus, and subsequent transverse myelitis.
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3/14. Pneumoencephalomeningitis secondary to infected lumbar arthrodesis with a fistula: a case report.

    pneumocephalus associated with spinal problems is very rare. association with encephalomeningitis secondary to a fistula after an infected elective lumbar spine fusion has not been previously reported. The authors report a case in which the clinical onset of pneumoencephalomeningitis occurred after an airplane flight. CT-scan and lumbar puncture were used to make diagnosis; the treatment was based on parenteral antibiotics. The symptoms and signs of infection and neurological deficit resolved but the fistula remained. diagnosis in such cases must be based upon CT-scan and lumbar puncture. Treatment should consist of systemic antibiotic therapy. Surgical management of infection and fistula is desirable, should the status of the patient allow such a treatment. In any case, as airplane flights in such cases may predispose to pneumocephalus, patients with an infected CSF fistula should avoid airplane flights until the problem is solved.
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4/14. pneumocephalus as a cause for headache.

    BACKGROUND: pneumocephalus can be a cause of headache, but is easily overlooked in some clinical circumstances. CASE STUDY: A 35-year-old woman developed severe headache of abrupt onset during an epidural blood patch procedure done for a post-lumbar puncture headache. A brain CT scan showed subarachnoid air even though there was no evidence of a dural puncture having occurred during the procedure. RESULTS: The experience of our patient, and a review of the literature suggests that air injected into the epidural space during use of the "loss of resistance" technique can enter the subarachnoid space if a dural puncture site from a previous lumbar puncture is present. CONCLUSIONS: pneumocephalus should be considered as a potential cause for a severe headache occurring in association with epidural procedures, and also in a number of other clinical settings. Use of a high inspired air oxygen concentration can hasten absorption of an intracranial air collection.
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5/14. pneumocephalus following an epidural blood patch.

    pneumocephalus is a rare complication of epidural block. We report a case of pneumocephalus complicating an epidural blood patch performed 3 days after unintentional dural puncture. pneumocephalus may occur during an epidural blood patch procedure, even if the epidural needle tip is within the epidural space.
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6/14. Temporary trigeminal disorder as a result of pneumocephalus after subarachnoid block.

    A patient was scheduled for inguinal herniorrhaphy under subarachnoid block. Lumbar puncture was difficult and several attempts were needed before it could be achieved. During the immediate postoperative period, the patient developed paraesthesia and anaesthesia on the right side of the face, mostly in the nose, cheek and upper lip areas. A CT scan showed a small pneumocephalus at the level of the brainstem. The symptoms persisted for approximately 70 min, after which they disappeared.
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7/14. post-dural puncture headache, intracranial air and obstetric anesthesia.

    Recently, a controversy has arisen as to whether air or saline should be recommended for the correct localization of the epidural space with the loss of resistance technique. I report a case of a previously healthy parturient who developed pneumocephalus and severe headache following the use of the loss of resistance to air (LORA) technique to identify the epidural space. This case report raises one more time the question about the safety of the LORA technique for labor analgesia.
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8/14. pneumocephalus and presumed meningitis following inconspicuous penetrating periocular trauma.

    PURPOSE: To report a case of serious intracranial complications in an adolescent youth following a seemingly trivial periocular injury. methods: An adolescent youth was examined and discharged after a small penetrating injury to his left medial canthus. He later presented with blurred vision, nausea and mild pyrexia and underwent a computed tomography (CT) scan of the head and orbits as well as a lumbar puncture. RESULTS: The CT scan revealed a fracture in the cribriform plate of the ethmoid bone and the medial orbital wall, as well as pneumocephalus. The lumbar puncture revealed 3000 white cells/mm3 in the cerebrospinal fluid (CSF). After treatment with meningitic doses of intravenous antibiotics, a significant improvement was noted. CONCLUSIONS: A CT scan, instead of an ordinary head radiograph, may be considered as a first-choice mode of diagnosis in evaluating even inconspicuous penetrating periocular wounds. Early administration of meningitic doses of antibiotics may significantly improve prognosis.
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9/14. pneumorrhachis following lumbar puncture: a case report.

    We report a rare case of pneumorrhachis following lumbar puncture. A 4-year-old boy was admitted to our hospital with seizures following a head injury and upper respiratory infection. Lumbar puncture was performed to rule out central nervous system infection. In response to leg pain and weakness a few hours after the procedure, lumbar spine computed tomography (CT) revealed pneumorrhachis at the level of L5-S1. In a follow-up CT scan 3 days later, the pneumorrhachis resolved spontaneously. pneumorrhachis following diagnostic lumbar puncture is an extremely rare condition. We discuss pneumorrhachis and review cases in the literature.
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10/14. Tension pneumocephalus in brain abscess after simple puncture-drainage.

    A case of tension pneumocephalus within the cavity of a brain abscess after simple puncture-drainage is reported. This possibility has to be taken into consideration when a worsening in the clinical situation of the patient occurs after this procedure.
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